Individual
DR. JOHN FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MPH
Contact information
Practice address
1700 CERRILLOS RD, SANTA FE, NM 87505-3554
(505) 946-9273
Mailing address
1522 CERRO GORDO RD, SANTA FE, NM 87501-6143
(505) 982-9002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
95-54
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S2125
—
NM
Enumeration date
09/26/2006
Last updated
09/26/2011
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