Organization
TEDOMER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY NMN DOMER MD (MEDICAL DIRECTOR)
(505) 783-4045
Entity
Organization
Contact information
Practice address
3720 CHURCH ROCK RD, GALLUP, NM 87301-4572
(505) 722-2261
(505) 722-4732
Mailing address
3720 CHURCH ROCK RD, GALLUP, NM 87301-4572
(505) 722-2261
(505) 722-4732
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
12/28/2007
Last updated
01/03/2008
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