Healthcare Provider Details

I. General information

NPI: 1659496545
Provider Name (Legal Business Name): PATRICK ANDREW LAUGHLIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SANTA ANA LOOP
PLACITAS NM
87043-9437
US

IV. Provider business mailing address

37 SANTA ANA LOOP
PLACITAS NM
87043-9437
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-1102
  • Fax:
Mailing address:
  • Phone: 505-867-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-1254-04
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: