Individual
STEVEN JOHN PETRAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 NORTH MUNDO, DULCE, NM 87528-2725
(575) 759-3291
(575) 759-7294
Mailing address
500 NORTH MUNDO, DULCE, NM 87528-1010
(575) 759-3291
(575) 759-7294
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NM96-117
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000S5584
MEDICAID PROVIDER #
NM
01
—
8HN067
MEDICARE PTAN #
NM
01
—
HSZ196
MEDICARE PART B #
NM
05
—
K3526
—
NM
Enumeration date
12/08/2006
Last updated
08/11/2011
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