Healthcare Provider Details

I. General information

NPI: 1437331980
Provider Name (Legal Business Name): JOHN R. HUXSOL CASE MANAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SIPAPU ST BOX 6952
TAOS NM
87571-6489
US

IV. Provider business mailing address

# 4 BLACK BEAR ROAD
ARROYO SECO NM
87514
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-5857
  • Fax: 575-758-5860
Mailing address:
  • Phone: 575-776-1425
  • Fax: 575-776-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: