Individual
ANDREW THOMAS THEUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
903 5TH ST # C, ESTANCIA, NM 87016-1155
(505) 384-2777
Mailing address
PO BOX 305, EDGEWOOD, NM 87015-0305
(706) 575-8004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2019-0052
NM
Other
Enumeration date
05/28/2019
Last updated
07/16/2019
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