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General NPI Number Information
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NPI Number | 1164475828
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Entity Type | Organization
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Legal Business Name | PC MARK RACE MD PLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 1501 10TH ST
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5044
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Country | US
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Telephone | 575-446-5900
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Fax | 575-446-5939
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Provider Business Mailing Address
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Address Line | 1501 10TH ST
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5044
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Country | US
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Telephone | 575-446-5900
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Fax | 575-446-5939
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES MARK RACE
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Credential | M.D.
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Telephone | 575-446-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD2009-0724
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License Number State | NM
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