Individual
DAVID EATON BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
901 W HICKORY, DEMING, NM 88030
(505) 546-2174
Mailing address
PO BOX 1349, SILVER CITY, NM 88062
(505) 546-2174
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I05272
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
75184281
—
NM
Enumeration date
09/13/2006
Last updated
07/08/2007
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