Individual
DR. EDWIN EMMANUEL NEBBLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 FOSTER LANE, RESERVE, NM 87830-0710
(575) 533-6456
(575) 533-6767
Mailing address
2837 HIGHWAY 32, QUEMADO, NM 87829-9118
(575) 313-6070
(575) 754-5409
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
99-267
NM
207Q00000X
Family Medicine Physician
G152996
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99-267
STATE LICENSE
NM
Enumeration date
11/03/2005
Last updated
09/24/2024
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