Animas Dermatology MD PC – Specialist

Key facts

NPI: 1063576148
Entity type: Organization (NPI type 2)
Primary specialty: Specialist 174400000X
License: 97-254 (NM)
Legal business name: ANIMAS DERMATOLOGY MD PC
Practice address: 4801 N Butler Ave Ste 9101
Farmington, NM 87401-3300
Phone: (505) 324-8375
Fax: (505) 327-4638
NPI assigned: Dec 21, 2006
Organization subpart: No

Authorized official

Name: Dr. Jean A Graham, M.D.
Title: Ceo
Phone: (505) 324-8375

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

William Thomas Williams, MD Otolaryngology Physician · Durango, CO · NPI 1033144621

NPD (past)

National Provider Directory

Locations

4801 N Butler Ave
Ste 9101
Farmington, NM 87401
Phone (505) 324-8375

615 N Butler Ave
Farmington, NM 87401
Phone (505) 324-8375

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Specialist Group: 193400000X SINGLE SPECIALTY GROUP	174400000X	97-254	NM	Yes

Addresses

Primary practice location

4801 N Butler Ave Ste 9101
Farmington, NM 87401-3300

Mailing address

1654 County Road 120
Hesperus, CO 81326-9752

Other identifiers

Identifier	Type	State	Issuer
NM012425	Other	NM	BLUE CROSS BLUE SHIELD NM
Q2833	Medicaid	NM

Other providers in Farmington, NM

All providers in Farmington, NM · Specialist in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.