Individual
SEAN FAHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 E 30TH ST, BLDG B, STE 102, FARMINGTON, NM 87401-8990
(505) 324-1000
(505) 324-1199
Mailing address
2300 E 30TH ST, STE C2, FARMINGTON, NM 87401-8991
(505) 324-1000
(505) 324-1199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
98-47
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080153393
RAILROAD RETIREMENT
—
01
—
12988
LOEVLACE
NM
01
—
201013243
PRESBYTERIAN HEALTH PLAN
NM
01
—
32756
PRESBYTERIAN SALUD
NM
01
—
NM004194
BLUE CROSS
NM
05
—
Q3766
—
NJ
Enumeration date
01/09/2006
Last updated
08/20/2019
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