Healthcare Provider Details

I. General information

NPI: 1205942885
Provider Name (Legal Business Name): JAMES E. SALTZ, JR. M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S 1ST ST
TUCUMCARI NM
88401-2707
US

IV. Provider business mailing address

PO BOX 628
TUCUMCARI NM
88401-0628
US

V. Phone/Fax

Practice location:
  • Phone: 505-461-2222
  • Fax: 505-461-2255
Mailing address:
  • Phone: 505-461-2222
  • Fax: 505-461-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68-163
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR22638
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR63323
License Number StateNM

VIII. Authorized Official

Name: JAMES EDWIN SALTZ
Title or Position: ADMINISTRATOR/OWNER
Credential: M.D.
Phone: 505-461-2222