# PROFESSIONAL PATHOLOGY SERVICES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083784177
- **Authorized official:** MR. JOHN DAVID HARRIS MD (PRESIDENT PROFESSIONAL PATHOLOGY SE)
- **Authorized official phone:** (505) 769-7257

## Contact information

- **Practice address:** 2100 N MLK BLVD, PLAINS REGIONAL MEDICAL CENTER, CLOVIS, NM 88101
- **Practice address phone:** (505) 769-7257
- **Practice address fax:** (505) 769-7243
- **Mailing address:** 417 INNSDALE TERRACE, APT B, CLOVIS, NM 88101
- **Mailing address phone:** (505) 762-0824
- **Mailing address fax:** (505) 769-7243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 2272A | WY | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 8944 | NM | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 08/22/2020