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General NPI Number Information
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NPI Number | 1215920426
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Entity Type | Organization
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Legal Business Name | NEW MEXICO BRAIN INSTITUTE, INC.
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 108 COTTONWOOD DR
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8219
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Country | US
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Telephone | 575-434-0901
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Fax | 575-437-1992
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Provider Business Mailing Address
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Address Line | 108 COTTONWOOD DR
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8219
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Country | US
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Telephone | 575-434-0901
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Fax | 575-437-1992
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | JOHN PAUL SIMMONS
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Credential | MD
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Telephone | 505-434-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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