Healthcare Provider Details

I. General information

NPI: 1770639585
Provider Name (Legal Business Name): DELORES ANNE ENDRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEL ANNE ENDRES M.D.

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PASEO DEL PUEBLO SUR SUITE 150
TAOS NM
87571-6070
US

IV. Provider business mailing address

630 PASEO DEL PUEBLO SUR SUITE 150
TAOS NM
87571-6070
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-3005
  • Fax: 575-758-7010
Mailing address:
  • Phone: 575-758-3005
  • Fax: 575-758-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85-22
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: