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General NPI Number Information
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NPI Number | 1366541252
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Entity Type | Organization
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Legal Business Name | ZIA FAMILY HEALTHCARE PC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 1315 N POPE ST
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City | SILVER CITY
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State | NM
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Zip | 88061-5143
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Country | US
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Telephone | 575-534-4299
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Fax | 575-538-5651
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Provider Business Mailing Address
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Address Line | 1315 N POPE ST
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City | SILVER CITY
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State | NM
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Zip | 88061-5143
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Country | US
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Telephone | 575-534-4299
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Fax | 575-538-5651
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY K KOURY
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Credential | MD
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Telephone | 575-534-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2003-0255
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License Number State | NM
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