Individual
JOHN D FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
US HWY 491NORTH, NORTHERN NAVAJO MEDICAL CENTER, SHIPROCK, NM 87420
(505) 368-7038
Mailing address
PO BOX 160, NORTHERN NAVAJO MEDICAL CENTER, SHIPROCK, NM 87420
(505) 368-7038
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1063
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08010639
—
CO
05
—
430257
—
AZ
05
—
R4992
—
NM
Enumeration date
03/14/2007
Last updated
03/11/2008
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