Unknown Individual – Family Medicine Physician, NPI 1003861618
Family Medicine Physician
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NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
133 Corporate Dr Ste 5
Bangor, ME 044014312
Phone: (207) 848-9084
Fax: (207) 848-9087
Type: Location
350 Lyckman Pl
Fountain, CO 808172861
Phone: (719) 632-5700
Type: Location
120 Llano St
Aztec, NM 874102172
Phone: (505) 334-3404
Fax: (505) 334-3486
Type: Location
Farmington Post Office, 113, Elm Street, Farmington, Dakota County, Minnesota, 55024, United States
FARMINGTON, NM 874996210
Phone: (505) 609-2258
Fax: (505) 609-2259
Type: Mailing
102, Llano Street, Aztec, San Juan County, New Mexico, 87410, United States
AZTEC, NM 874102172
Phone: (505) 334-9440
Fax: (505) 334-8750
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 04401)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | NM | |
| Internal Medicine, Hospitalist, Internal Medicine | NM | |
| Physician Assistant | TX | |
| - | MN | |
| Clinical Psychologist | TX | |
| - | NM | |
| N E U R O L O G Y | TX | |
| Internal Medicine | NM | |
| O B S T E T R I C S/ G Y N E C O L O G Y | NM | |
| - | NM |
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