Organization
SANTA FE FAMILY AND FUNCTIONAL MEDICINE PC
Active
Other names
Isis Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE E GOLLUB MD (PRESIDENT)
(505) 983-8387
Entity
Organization
Contact information
Practice address
401 BOTULPH LANE, SANTA FE, NM 87505
(505) 983-8387
(505) 820-2733
Mailing address
401 BOTULPH LANE, SANTA FE, NM 87505
(505) 983-8387
(505) 820-2733
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49064
—
NM
Enumeration date
11/07/2006
Last updated
07/13/2017
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