Healthcare Provider Details

I. General information

NPI: 1801853312
Provider Name (Legal Business Name): PER G BJORKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 04/11/2008

III. Provider practice location address

1397 WEIMER ROAD
TAOS NM
87571
US

IV. Provider business mailing address

1397 WEIMER ROAD
TAOS NM
87571
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-8833
  • Fax: 575-751-5718
Mailing address:
  • Phone: 505-758-8833
  • Fax: 575-751-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9617
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: