Organization
ANIMAS DERMATOLOGY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN A GRAHAM M.D. (CEO)
(505) 324-8375
Entity
Organization
Contact information
Practice address
4801 N BUTLER AVE STE 9101, FARMINGTON, NM 87401-3300
(505) 324-8375
(505) 327-4638
Mailing address
1654 COUNTY ROAD 120, HESPERUS, CO 81326-9752
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
97-254
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM012425
BLUE CROSS BLUE SHIELD NM
NM
05
—
Q2833
—
NM
Enumeration date
12/21/2006
Last updated
08/17/2018
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