Individual
DR. JENNY HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
(505) 609-2259
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
45957
CO
207P00000X
Emergency Medicine Physician
A87959
CA
207P00000X
Emergency Medicine Physician
Primary
MD2009-0130
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A879590
MEDI-CAL PROVIDER NUMBER
CA
05
—
78401054
—
CO
Enumeration date
02/05/2007
Last updated
01/20/2014
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