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Individual

MR. GARY JOHN TEARE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
3451 N BUTLER AVE, FARMINGTON, NM 87401
(505) 566-1915
(505) 566-1918
Mailing address
3451 N BUTLER AVE, FARMINGTON, NM 87401-2357
(505) 566-1915
(505) 566-1918

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
98-PA13
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
25407236
NM
Enumeration date
09/15/2006
Last updated
12/12/2007
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