Individual
PATRICK J C DE BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 N 3RD AVE, CLAYTON, NM 88415-3300
(575) 374-2273
(575) 374-2498
Mailing address
315 N 3RD AVE, CLAYTON, NM 88415-3300
(575) 374-2273
(575) 374-2498
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301044788
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4879970
—
MI
Enumeration date
07/28/2006
Last updated
08/16/2010
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