Individual
MATHEW MCDERMOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
500 E CHACO ST, AZTEC, NM 87410-2170
(505) 334-9414
Mailing address
402 UTE AVE, AZTEC, NM 87410-2232
(505) 793-0028
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
606
NM
Other
Enumeration date
04/08/2016
Last updated
04/08/2016
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