MEDICARE: SANDRO B PARISI 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	2085R0202X	Diagnostic Radiology Physician	K9144	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00002145	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	89482R	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1750373288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRO B PARISI MD

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD BLDG 1
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3259
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:	575-532-7025

Provider Business Practice Location Address
First Line	:	4311 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-556-6717
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/30/2020

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Directions to “ SANDRO B PARISI MD” Practice Location

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