Healthcare Provider Details

I. General information

NPI: 1912039413
Provider Name (Legal Business Name): DRS. ANDREWS AND JOHNSON OF THE MESILLA VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E IDAHO AVE #17
LAS CRUCES NM
88005-3257
US

IV. Provider business mailing address

225 E IDAHO AVE #17
LAS CRUCES NM
88005-3257
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-5525
  • Fax: 575-541-0498
Mailing address:
  • Phone: 575-526-5525
  • Fax: 575-541-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number85-3
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number77-190
License Number StateNM

VIII. Authorized Official

Name: DR. GREGORY E JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 575-526-5525