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General NPI Number Information
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NPI Number | 1922045319
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Entity Type | Organization
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Legal Business Name | DJRJ3 MEDICAL SERVICES INC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 840 LOBO CANYON RD
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City | GRANTS
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State | NM
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Zip | 87020-2172
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Country | US
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Telephone | 505-404-9132
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Fax | 505-393-1076
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Provider Business Mailing Address
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Address Line | PO BOX 7191
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City | GRANTS
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State | NM
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Zip | 87020-7191
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Country | US
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Telephone | 505-404-9132
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Fax | 505-393-1076
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH M CHARLES JR.
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Credential | MD
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Telephone | 505-404-9132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD2013-0395
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License Number State | NM
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