Individual
JENNIFER MCCAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
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
073127
GA
207P00000X
Emergency Medicine Physician
Primary
A-2125-18
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28980778
—
NM
Enumeration date
08/06/2008
Last updated
04/05/2018
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