Healthcare Provider Details

I. General information

NPI: 1851432835
Provider Name (Legal Business Name): JONAS R. SKARDIS DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR STE 200
SANTA FE NM
87505-7686
US

IV. Provider business mailing address

460 SAINT MICHAELS DR STE 200
SANTA FE NM
87505-7686
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-5551
  • Fax:
Mailing address:
  • Phone: 505-988-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number159RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: