Healthcare Provider Details

I. General information

NPI: 1164460507
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF RATON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S 3RD ST
RATON NM
87740-4005
US

IV. Provider business mailing address

411 S 3RD ST
RATON NM
87740-4005
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-3626
  • Fax: 505-445-8649
Mailing address:
  • Phone: 505-445-3626
  • Fax: 505-445-8649

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: TERRI J SEGOTTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-445-3626