Organization
HIGH DESERT NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY K WILLIAMS JR. MD (PRINCIPAL)
(505) 892-8915
Entity
Organization
Contact information
Practice address
4131 BARBARA LOOP SE, SUITE 1-A, RIO RANCHO, NM 87124-1362
(505) 892-8915
(505) 994-3028
Mailing address
PO BOX 44430, RIO RANCHO, NM 87174-4430
(505) 892-8915
(505) 994-3028
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM009T07
BCBS
NM
01
—
201047864
PHP & SALUD
NM
05
—
23432
—
NM
01
—
C100521093
UNITED AMERICAN
NM
01
—
NM9999
MUTUAL OF OMAHA
NM
Enumeration date
09/25/2006
Last updated
12/30/2008
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