Organization
AZTEC FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN POE (OWNER)
(505) 334-2852
Entity
Organization
Contact information
Practice address
406 S PARK AVE, AZTEC, NM 87410-2226
(505) 334-2852
Mailing address
406 S PARK AVE, AZTEC, NM 87410-2226
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
A-834-86
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40931
—
NM
Enumeration date
07/12/2007
Last updated
05/20/2008
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