Individual
STACEY DIMITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1423 E ROOSEVELT AVE, GRANTS, NM 87020-2245
(505) 287-6500
(505) 287-5393
Mailing address
1423 E ROOSEVELT AVE, GRANTS, NM 87020-2245
(505) 287-6500
(505) 287-5393
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7613
KS
Other
Enumeration date
06/14/2011
Last updated
09/02/2020
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