Individual
JASPER BRAYTON TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1100 CENTRAL AVE SE, PMG EMERGENCY MEDICINE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2010-0080
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71122842
—
NM
Enumeration date
12/21/2010
Last updated
11/06/2015
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