Healthcare Provider Details

I. General information

NPI: 1194768051
Provider Name (Legal Business Name): JEANMARIE K SALINAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W COUNTRY CLUB RD
ROSWELL NM
88201-5892
US

IV. Provider business mailing address

305 W COUNTRY CLUB RD
ROSWELL NM
88201-5892
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-6322
  • Fax: 575-622-6888
Mailing address:
  • Phone: 575-622-6322
  • Fax: 575-622-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7828
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberH4668
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2017-0677
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: