Organization
PANGEA MEDICAL LLC
Active
Other names
Pangea Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN R BLACK MD (MANAGING MEMBER)
(575) 624-2095
Entity
Organization
Contact information
Practice address
405 W COUNTRY CLUB RD, ROSWELL, NM 88201-5209
(575) 624-2095
(575) 208-0780
Mailing address
PO BOX 8244, ROSWELL, NM 88202-8244
(575) 624-2095
(575) 208-0780
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2011-0547
NM
2084P0800X
Psychiatry Physician
Primary
MD2011-0547
NM
Other
Enumeration date
05/03/2016
Last updated
10/21/2022
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