Healthcare Provider Details

I. General information

NPI: 1982656948
Provider Name (Legal Business Name): DOROTHY F GAULT-MCNEMEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 MCNUTT ROAD
SANTA TERESA NM
88008-1590
US

IV. Provider business mailing address

PO BOX 1590
SANTA TERESA NM
88008-1590
US

V. Phone/Fax

Practice location:
  • Phone: 505-589-1144
  • Fax: 505-589-2008
Mailing address:
  • Phone: 505-589-1144
  • Fax: 505-589-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNMMD81200
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: