Organization
LEGACY FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT HARTLINE (ADMINISTRATOR)
(480) 498-9086
Entity
Organization
Contact information
Practice address
1808 E AZTEC AVE STE 6, GALLUP, NM 87301-4946
(505) 863-9374
Mailing address
PO BOX 402, LUPTON, AZ 86508-1402
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/29/2022
Last updated
03/29/2022
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