Individual
DR. IMAD A.R. IDRISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
(575) 522-1059
(575) 522-3652
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
7841
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02782
—
NM
Enumeration date
07/14/2005
Last updated
10/31/2008
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