Organization
IMAD IDRISS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMAD IDRISS (PRESIDENT)
(575) 522-1059
Entity
Organization
Contact information
Practice address
2427 S TELSHOR BLVD, LAS CRUCES, NM 88011-5049
(575) 522-1059
(575) 522-3652
Mailing address
2427 S TELSHOR BLVD, LAS CRUCES, NM 88011-5049
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
78-41
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02782
—
NM
Enumeration date
07/28/2008
Last updated
07/28/2008
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