Healthcare Provider Details

I. General information

NPI: 1801190004
Provider Name (Legal Business Name): 24ON PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5069
US

IV. Provider business mailing address

PO BOX 403631
ATLANTA GA
30384-3631
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-5457
  • Fax: 575-521-5471
Mailing address:
  • Phone: 770-740-0895
  • Fax: 770-740-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAN A. FULLER
Title or Position: SECRETARY
Credential:
Phone: 770-740-0895