Healthcare Provider Details

I. General information

NPI: 1932261831
Provider Name (Legal Business Name): JOHN ALAN MACFARLANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PASEO DEL PUEBLO SUR STE 150 BOX 5436 NDCBU
TAOS NM
87571-7002
US

IV. Provider business mailing address

630 PASEO DEL PUEBLO SUR STE 150 BOX 5436 NDCBU
TAOS NM
87571-7002
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAA1356
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberAA1356
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: