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Organization
PROFESSIONAL PATHOLOGY SERVICES PC
Active
Organization
PROFESSIONAL PATHOLOGY SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN DAVID HARRIS MD (PRESIDENT PROFESSIONAL PATHOLOGY SE)
(505) 769-7257
Entity
Organization
Contact information
Practice address
2100 N MLK BLVD, PLAINS REGIONAL MEDICAL CENTER, CLOVIS, NM 88101
(505) 769-7257
(505) 769-7243
Mailing address
417 INNSDALE TERRACE, APT B, CLOVIS, NM 88101
(505) 762-0824
(505) 769-7243
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
2272A
WY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
8944
NM
Other
Enumeration date
11/08/2006
Last updated
08/22/2020
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