Individual
EDWARD JOSEPH NEIDHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
103 S SAINT FRANCIS DR, SUITE C, SANTA FE, NM 87501-2458
(505) 988-5667
(505) 820-1632
Mailing address
103 S SAINT FRANCIS DR, SUITE C, SANTA FE, NM 87501-2458
(505) 988-5667
(505) 820-1632
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
89267
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
05
—
41814
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
12/15/2006
Last updated
06/27/2013
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