Healthcare Provider Details

I. General information

NPI: 1922045319
Provider Name (Legal Business Name): DJRJ3 MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LOBO CANYON RD
GRANTS NM
87020-2172
US

IV. Provider business mailing address

PO BOX 7191
GRANTS NM
87020-7191
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-9132
  • Fax: 505-393-1076
Mailing address:
  • Phone: 505-404-9132
  • Fax: 505-393-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2013-0395
License Number StateNM

VIII. Authorized Official

Name: DR. JOSEPH M CHARLES JR.
Title or Position: OWNER
Credential: MD
Phone: 505-404-9132