Healthcare Provider Details

I. General information

NPI: 1649374380
Provider Name (Legal Business Name): NORTHERN NEW MEXICO SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST ROAD SUITE #125
LOS ALAMOS NM
87544
US

IV. Provider business mailing address

3917 WEST ROAD SUITE #125
LOS ALAMOS NM
87544
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-3030
  • Fax: 505-662-9024
Mailing address:
  • Phone: 505-661-3030
  • Fax: 505-662-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY J BARKER
Title or Position: SURGEON OWNER
Credential: MD
Phone: 505-661-3030