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General NPI Number Information
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NPI Number | 1477675015
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Entity Type | Individual
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Provider Name | JOHN D YERXA PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 2743B HWY 35N
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City | MIMBRES
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State | NM
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Zip | 88049
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Country | US
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Telephone | 575-536-3990
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Fax | 575-536-3991
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Provider Business Mailing Address
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Address Line | 530 DE MOSS ST
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City | LORDSBURG
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State | NM
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Zip | 88045-2618
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Country | US
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Telephone | 575-542-8384
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Fax | 575-542-8367
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2007-0006
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License Number State | NM
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