Douglas A. North, PA-C
Individual provider Active NPI Medical Physician Assistant · Penasco, NM
NPI 1720071186 · NPPES record last updated Jul 15, 2013
Key facts
- NPI
- 1720071186
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 2001-PA27 (NM)
- Practice address
- 15136 St. Rd. 75
Penasco, NM 87553-0238 - Phone
- (575) 587-2205
- Fax
- (575) 587-1944
- NPI assigned
- Aug 31, 2005
- Sex
- Male
- Sole proprietor
- No
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001-PA27 | NM | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Centro Family Health | Past | Accepting new patients | |
| El Centro Family Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2001-PA27 | NM | Yes |
Addresses
Primary practice location
15136 St. Rd. 75
Penasco, NM 87553-0238
Mailing address
PO Box 158
538 N. Paseo de Onate
Espanola, NM 87532-0158
Phone (505) 753-7218
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81958757 | Medicaid | NM | |
| NM400307 | Other | NM | MEDICARE PTAN |
Other providers in Penasco, NM
- Michelle Hamilton
- Lizabeth L. Jamison
- Mas Comunidad
- Shannon Monique Medina
- Rachel Moore
- Mia G Pacheco
- Penasco Independent Schools
- Picuris Medical Center
- Picuris Medical Center
- Picuris Pueblo
All providers in Penasco, 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 Jul 15, 2013. 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.