Individual
DR. IVAN JOHN CHRISTOV NICOLOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
BIA RTE 125, PINE HILL, NM 87357
(505) 775-3271
(505) 775-3930
Mailing address
BIA RTE 125, 310, PINE HILL, NM 87357
(505) 775-3271
(505) 775-3930
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
MD20060115
NM
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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