Individual
ALEXANDER THOMAS VINING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1010 SPRUCE ST, ENERGENCY MEDICINE - ESPANOLA, ESPANOLA, NM 87532-2746
(505) 753-7111
(505) 367-0263
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2021-0060
NM
Other
Enumeration date
07/10/2021
Last updated
02/08/2024
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