Individual
DUANE E VANDERSLICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
816 W MAPLE ST, FARMINGTON, NM 87401-5631
(505) 327-3634
(505) 327-2104
Mailing address
816 W MAPLE ST, FARMINGTON, NM 87401-5631
(505) 327-3634
(505) 327-2104
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
83-134
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201010266
PRESBYTERIAN HEALTH/SALUD
NM
05
—
22095
—
NM
01
—
2836
BLUE CROSS BLUE SHIELD
NM
01
—
850364974
TAX ID
NM
Enumeration date
09/17/2006
Last updated
11/12/2008
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