Healthcare Provider Details

I. General information

NPI: 1265437305
Provider Name (Legal Business Name): RICHARD PINON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W COUNTRY CLUB RD STE 230
ROSWELL NM
88201-5240
US

IV. Provider business mailing address

300 W COUNTRY CLUB RD STE 230
ROSWELL NM
88201-5240
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-1411
  • Fax: 575-624-5630
Mailing address:
  • Phone: 575-622-1411
  • Fax: 575-624-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number98-135
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: