Organization
TAOS SURGICAL SPECIALTIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY R COCKBURN (PRACTICE MANAGER)
(575) 751-0334
Entity
Organization
Contact information
Practice address
1399 WEIMER RD, SUITE # 600, TAOS, NM 87571-6340
(575) 751-0334
(575) 751-0297
Mailing address
1399 WEIMER RD, SUITE # 600, TAOS, NM 87571-6340
(575) 751-0334
(575) 751-0297
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
74-132
NM
174400000X
Specialist
99-256
NM
174400000X
Specialist
Primary
MD2004-0101
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2122478
—
NM
05
—
29805325
—
NM
05
—
66785
—
NM
Enumeration date
07/10/2007
Last updated
11/06/2007
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