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Individual

TRAVIS ELY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
105 BERTHA RD STE B, TAOS, NM 87571-7148
(575) 758-4297
Mailing address
307 ESTE ES PL, TAOS, NM 87571-2000

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
08/16/2022
Last updated
02/13/2023
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