Patrick J C de Baca, M.D.
Individual provider Active NPI Surgery Physician · Clayton, NM
NPI 1386658094 · NPPES record last updated Aug 16, 2010
Key facts
- NPI
- 1386658094
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 4301044788 (MI)
- Practice address
- 315 N 3Rd Ave
Clayton, NM 88415-3300 - Phone
- (575) 374-2273
- Fax
- (575) 374-2498
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16006 | OK | MD | Pharmacist |
| 4301044788 | MI | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospital Grayling | Past | Accepting new patients | |
| Nemri Medical Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301044788 | MI | Yes |
Addresses
Primary practice location
315 N 3Rd Ave
Clayton, NM 88415-3300
Mailing address
315 N 3Rd Ave
Clayton, NM 88415-3300
Phone (575) 374-2273
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4879970 | Medicaid | MI |
Other providers in Clayton, NM
- Ball Investments Inc
- Sherina S Bickel
- Zachary C Bickel
- Deborah Blake-Brook
- Amber Bullington
- Care for You Health
- Care for You Health
- Chelsey Elizabeth Cates
- Becky Jo Claycomb
- Clayton Health Facilities LP
All providers in Clayton, NM · Surgery Physician 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 16, 2010. 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.