Individual
EDISON VIRGIL ETSITTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
465 SAINT MICHAELS DR, SUITE 202, SANTA FE, NM 87505-7670
(505) 984-0303
(505) 984-1116
Mailing address
465 SAINT MICHAELS DR, SUITE 202, SANTA FE, NM 87505-7670
(505) 984-0303
(505) 984-1116
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2002-0299
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003903
LOVELACE HEALTH/SALUD
NM
01
—
160058344
RAILROAD MEDICARE
—
01
—
201038402
PRESBYTERIAN HEALTH/SALUD
NM
05
—
50733826
—
NM
05
—
723040
—
AZ
01
—
850313268020
CHAMPUS
—
01
—
NM009C04
BC/BS
NM
01
—
PROVP12721
MOLINA
—
Enumeration date
01/06/2006
Last updated
02/10/2011
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