Organization
PEDIATRIC BEHAVIORAL MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES W MARTIN MD (PRESIDENT)
(575) 805-0849
Entity
Organization
Contact information
Practice address
2407 W PICACHO AVE, A104, LAS CRUCES, NM 88007-4124
(575) 805-0849
(575) 541-3617
Mailing address
2407 W PICACHO AVE, A104, LAS CRUCES, NM 88007-4124
(575) 805-0849
(575) 541-3617
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD2008-0370
NM
2084P0800X
Psychiatry Physician
MD2008-0370
NM
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD2008-0370
NM
Other
Enumeration date
04/03/2012
Last updated
02/26/2013
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