Organization
ADULT & PEDIATRIC UROLOGY, LLC
Active
Organization
ADULT & PEDIATRIC UROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN W MCCULLOCH M.D. (OWNER)
(505) 327-9111
Entity
Organization
Contact information
Practice address
2300 E 30TH ST, BLDG B SUITE 106, FARMINGTON, NM 87401-8990
(505) 327-9111
(505) 327-2730
Mailing address
2300 E 30TH ST, BLDG B SUITE 106, FARMINGTON, NM 87401-8990
(505) 327-9111
(505) 327-2730
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
87115
NM
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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