John D Yerxa, PA-C
Individual provider Active NPI Medical Physician Assistant · Mimbres, NM
NPI 1477675015 · NPPES record last updated Nov 24, 2008
Key facts
- NPI
- 1477675015
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA2007-0006 (NM)
- Practice address
- 2743B Hwy 35N
Mimbres, NM 88049 - Phone
- (575) 536-3990
- Fax
- (575) 536-3991
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2007-0006 | NM | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA2007-0006 | NM | Yes |
Addresses
Primary practice location
2743B Hwy 35N
Mimbres, NM 88049
Mailing address
530 De Moss St
Lordsburg, NM 88045-2618
Phone (575) 542-8384
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM300066 | Other | MEDICARE PTAN | |
| 57372764 | Medicaid | NM |
Other providers in Mimbres, NM
- Michael Joseph Amundson
- Katherine Victoria Beck
- De la Luz Creative Guidance LLC
- Erin E Joslin-Gay
- Beth Elaine Rieches
All providers in Mimbres, NM · Medical Physician Assistant 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 Nov 24, 2008. 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.