Healthcare Provider Details

I. General information

NPI: 1316358989
Provider Name (Legal Business Name): NEWMEXIDOC, PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S SAINT FRANCIS DR
SANTA FE NM
87505-3027
US

IV. Provider business mailing address

PO BOX 1846
SANTA FE NM
87504-1846
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-7791
  • Fax: 505-501-7792
Mailing address:
  • Phone: 505-501-7791
  • Fax: 505-501-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TROY EDWARD WATSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 505-501-7791