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Individual

JOHN DIRK WASSNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
465 SAINT MICHAELS DR, SUITE 110, SANTA FE, NM 87505-7670
(505) 954-8720
Mailing address
455 SAINT MICHAELS DR, MEDICAL STAFF OFFICE, SANTA FE, NM 87505-7601
(505) 820-5227

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD2006-0010
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10024478
LOVELACE
NM
01
202005441
PRESBYTERIAN HEALTH PLAN
01
2607463
UHC
05
80509568
NM
01
NM009X29
BCBS NM
NM
01
QMYPR0070898
MOLINA HEALTHCARE
Enumeration date
03/09/2006
Last updated
12/12/2007
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