MEDICARE: DJRJ3 MEDICAL SERVICES INC

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	207V00000X	Obstetrics & Gynecology Physician	MD2013-0395	NM

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	10-8990	OTHER	FL	RURAL HEALTH CLINIC PROVI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922045319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DJRJ3 MEDICAL SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 7191
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-7191
Country	:	US
Telephone Number	:	505-404-9132
Fax Number	:	505-393-1076

Provider Business Practice Location Address
First Line	:	840 LOBO CANYON RD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2172
Country	:	US
Telephone Number	:	505-404-9132
Fax Number	:	505-393-1076

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH M CHARLES JR.
Credential	:	MD
Telephone Number	:	505-404-9132

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/03/2015

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Directions to “DJRJ3 MEDICAL SERVICES INC ” Practice Location

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