Healthcare Provider Details

I. General information

NPI: 1104980572
Provider Name (Legal Business Name): DARLA H BEJNAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 US HIGHWAY 60 WEST SOCORRO GENERAL MEDICAL GROUP
SOCORRO NM
87801
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 575-838-4690
  • Fax: 575-838-4689
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2006-0715
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: