Healthcare Provider Details

I. General information

NPI: 1881619864
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF TAOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/24/2013
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: 505-758-3005
  • Fax: 505-758-7010
Mailing address:
  • Phone: 505-758-3005
  • Fax: 505-758-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0034
License Number StateNM

VIII. Authorized Official

Name: LAWRENCE HUGH SCHREIBER
Title or Position: PARTNER
Credential: MD
Phone: 505-758-3005