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Individual

MR. ALLEN MICHAEL FREY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
R.T.

Contact information

Practice address
JICARILLA APACHE HEALTH CARE CENTER, 12000 STONE LAKE ROAD, DULCE, NM 87528
(505) 759-3291
Mailing address
HC 75 BOX 189, CHAMA, NM 87520-9712
(505) 756-7219

Taxonomy

Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000K3526
NM
01
HSZ196
MEDICARE PART B
NM
Enumeration date
10/25/2006
Last updated
05/27/2008
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