Healthcare Provider Details

I. General information

NPI: 1366541252
Provider Name (Legal Business Name): ZIA FAMILY HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N POPE ST
SILVER CITY NM
88061-5143
US

IV. Provider business mailing address

1315 N POPE ST
SILVER CITY NM
88061-5143
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-4299
  • Fax: 575-538-5651
Mailing address:
  • Phone: 575-534-4299
  • Fax: 575-538-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2003-0255
License Number StateNM

VIII. Authorized Official

Name: GREGORY K KOURY
Title or Position: OWNER
Credential: MD
Phone: 575-534-4299