Individual
MR. JONATHAN R KEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2111 LOBO CANYON RD, WNMCF, GRANTS, NM 87020
(505) 876-8360
Mailing address
PO BOX 26028, CREDENTIALING/ CLINICIAN SERVICES, ALBUQUERQUE, NM 87125-6028
(505) 237-8700
(505) 237-8703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
M-9759
ID
207Q00000X
Family Medicine Physician
Primary
MD2011-0623
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1055258317
AMERICAN BOARD OF FAMILY MEDICINE CERTIFICATION
NM
Enumeration date
01/17/2007
Last updated
10/01/2025
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