Healthcare Provider Details

I. General information

NPI: 1700040227
Provider Name (Legal Business Name): GERALD DUKEMINIER D.O.M.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

28415 US 285
LAMY NM
87540-9510
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4210
  • Fax:
Mailing address:
  • Phone: 505-466-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number099RX1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: