Individual
REGINA LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00040740
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4112895
—
NM
05
—
80038735
—
CO
05
—
832081
—
AZ
Enumeration date
07/31/2006
Last updated
03/12/2014
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