Healthcare Provider Details

I. General information

NPI: 1366671570
Provider Name (Legal Business Name): WILLIAM JAMES NEGRI IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050A 2ND ST SE 377AMDS/SGPF
KIRTLAND AFB NM
87117-5522
US

IV. Provider business mailing address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5522
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3714
  • Fax:
Mailing address:
  • Phone: 505-846-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: