Healthcare Provider Details

I. General information

NPI: 1295832889
Provider Name (Legal Business Name): SUSAN LEE PULLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CALLE DE LUZ
SANTA FE NM
87506-2186
US

IV. Provider business mailing address

39 CALLE DE LUZ
SANTA FE NM
87506-2186
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4590
  • Fax:
Mailing address:
  • Phone: 505-982-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number15321
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number96-120
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: