Individual
MR. DOUGLAS A. NORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
15136 ST. RD. 75, PENASCO, NM 87553-0238
(575) 587-2205
(575) 587-1944
Mailing address
PO BOX 158, 538 N. PASEO DE ONATE, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2001-PA27
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81958757
—
NM
01
—
NM400307
MEDICARE PTAN
NM
Enumeration date
08/31/2005
Last updated
07/15/2013
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