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Individual

ERIC M KETCHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
(505) 609-2259
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2004-0044
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
72982781
NM
Enumeration date
02/14/2006
Last updated
09/11/2018
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