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General NPI Number Information
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NPI Number | 1609051507
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Entity Type | Organization
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Legal Business Name | PRIMARY HEALTHCARE, INC.
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 505 E 20TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-2105
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Country | US
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Telephone | 505-324-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 505 E 20TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-2105
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Country | US
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Telephone | 505-324-6300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAN A DUNN
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Credential | M.D.
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Telephone | 505-324-6300
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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 | 90-188
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License Number State | NM
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