MEDICARE: PAUL A VAKSELIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2000120	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	020049262	OTHER	NM	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	850466870	OTHER	NM	CHAMPUS
2	54770	OTHER	NM	PRESBYTERIAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NM009426	OTHER	NM	BC/BS
5	31557	OTHER	NM	LOVELACE
6	850460870	OTHER	NM	CIMARRON SALUD
8	880110001	OTHER	NM	WPS TRICARE

General Provider Information

NPI Number	:	1710971015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL A VAKSELIS MD

Provider Business Mailing Address
First Line	:	PO BOX 1560
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88004-1560
Country	:	US
Telephone Number	:	505-647-8366
Fax Number	:	505-647-8387

Provider Business Practice Location Address
First Line	:	2909 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4701
Country	:	US
Telephone Number	:	505-522-5888
Fax Number	:	505-521-1876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	02/10/2009

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Directions to “ PAUL A VAKSELIS MD” Practice Location

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