Healthcare Provider Details

I. General information

NPI: 1114928298
Provider Name (Legal Business Name): ZIA FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 208
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

PO BOX 1560
LAS CRUCES NM
88004-1560
US

V. Phone/Fax

Practice location:
  • Phone: 505-532-1456
  • Fax: 505-522-6789
Mailing address:
  • Phone: 505-647-8366
  • Fax: 505-647-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DIANNE DUERKSEN
Title or Position: OWNER
Credential: MD
Phone: 505-532-1456