Organization
SANDROCK PODIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC HAAG MD (OWNER/PODIATRIST)
(505) 787-9035
Entity
Organization
Contact information
Practice address
4707 RIO ST, FARMINGTON, NM 87402-5323
(505) 787-9035
Mailing address
4707 RIO ST, FARMINGTON, NM 87402-5323
(505) 787-9003
(505) 291-3293
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6N8581
NM-GROUP MEDICARE PTAN
NM
05
—
74122355
—
NM
Enumeration date
10/06/2023
Last updated
08/23/2024
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