Organization
RIO GRANDE FOOT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L DEETZ D.P.M. (OWNER)
(575) 523-8566
Entity
Organization
Contact information
Practice address
710 S ALAMEDA BLVD, LAS CRUCES, NM 88005-2928
(575) 523-8566
(575) 525-2065
Mailing address
710 S ALAMEDA BLVD, LAS CRUCES, NM 88005-2928
(575) 523-8566
(575) 525-2065
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
NM142
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54072
—
NM
01
—
NM035303
BLUE CROSS BLUE SHIELD
NM
Enumeration date
12/29/2006
Last updated
05/14/2008
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