Individual
TIMOTHY DAVID MAYHEW
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
US HWY 491 N, SHIPROCK, NM 87420
(505) 368-6020
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6020
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25931
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04386370
—
CO
05
—
429060
—
AZ
05
—
Q9966
—
NM
Enumeration date
11/02/2005
Last updated
07/08/2007
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