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General NPI Number Information
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NPI Number | 1144275959
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Entity Type | Individual
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Provider Name | CHARLES MARK RACE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 2539 MEDICAL DR STE 110
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8720
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Country | US
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Telephone | 575-434-2116
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Fax | 575-434-2051
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Provider Business Mailing Address
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Address Line | 2669 SCENIC DR
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8700
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Country | US
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Telephone | 515-955-6767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD2009-0724
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License Number State | NM
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