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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16545
—
NM
Enumeration date
11/08/2006
Last updated
08/22/2020
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