Organization
SAN JUAN ONCOLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY D NEIDHART MD (MD, CEO)
(505) 564-6850
Entity
Organization
Contact information
Practice address
2325 E 30TH ST, FARMINGTON, NM 87401-8900
(505) 564-6850
(505) 564-6890
Mailing address
2325 E 30TH ST, FARMINGTON, NM 87401-8900
(505) 564-6850
(505) 564-6890
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207RX0202X
Medical Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020403599
ENERGY EMPLOYEES OCCU
NM
05
—
30179882
—
CO
01
—
700521049
MEDICARE TRAILBLAZERS
NM
05
—
788664
—
AZ
01
—
PROVP23839
CIMMARON SALUD MOLINA
NM
Enumeration date
10/25/2006
Last updated
06/24/2021
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