Organization
BLUE AND RED BIRD CORP PC
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALI M GHAFFARI SR. M.D. (MEDICAL DIRECTOR)
(505) 762-6492
Entity
Organization
Contact information
Practice address
815 W 14TH ST, CLOVIS, NM 88101-5514
(505) 762-6492
(505) 769-8236
Mailing address
815 W 14TH ST, CLOVIS, NM 88101-5514
(505) 762-6492
(505) 769-8236
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S2511
—
NM
Enumeration date
05/07/2007
Last updated
10/26/2016
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