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General NPI Number Information
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NPI Number | 1407097827
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Entity Type | Individual
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Provider Name | LEA PAZOS CREEKMUR O'DELL D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1010 SPRUCE ST
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City | ESPANOLA
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State | NM
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Zip | 87532-2724
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Country | US
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Telephone | 505-753-7111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2011010488
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036125848
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02003701A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A-2095-17
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License Number State | NM
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