Healthcare Provider Details

I. General information

NPI: 1851485247
Provider Name (Legal Business Name): TIMOTHY BAJEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 5TH ST STE A
SANTA FE NM
87505-6012
US

IV. Provider business mailing address

1919 5TH ST STE A
SANTA FE NM
87505-6012
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-9180
  • Fax: 833-450-5399
Mailing address:
  • Phone: 505-467-9180
  • Fax: 833-450-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number98215
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number98215
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: