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General NPI Number Information
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NPI Number | 1639339955
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Entity Type | Organization
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Legal Business Name | JAMES F. VAN PELT,III,M.D.,PHD, P.C.
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 313 W COUNTRY CLUB RD STE. 10
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City | ROSWELL
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State | NM
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Zip | 88201-5804
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Country | US
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Telephone | 575-622-0816
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Fax | 575-623-6838
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Provider Business Mailing Address
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Address Line | 313 W COUNTRY CLUB RD STE. 10
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City | ROSWELL
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State | NM
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Zip | 88201-5804
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Country | US
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Telephone | 575-622-0816
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Fax | 575-623-6838
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL NEUROLOGY
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Name | DR. JAMES F VAN PELT III
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Credential | M. D., PHD
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Telephone | 575-622-0816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 91 338
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License Number State | NM
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