Healthcare Provider Details

I. General information

NPI: 1285857664
Provider Name (Legal Business Name): LOS ALAMOS FAMILY PRACTICE P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD SUITE 130
LOS ALAMOS NM
87544-2275
US

IV. Provider business mailing address

3917 WEST RD SUITE 130
LOS ALAMOS NM
87544-2275
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP ALAN HERTZMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-662-2900