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General NPI Number Information
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NPI Number | 1205300647
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Entity Type | Individual
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Provider Name | LOUIS MAYER II MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2050A 2ND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-5522
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Country | US
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Telephone | 505-853-7377
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Fax |
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Provider Business Mailing Address
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Address Line | 11209 PARIS AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6333
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Country | US
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Telephone | 505-785-7374
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT790
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License Number State | NM
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