Individual
MR. DAVID GUSTAD DEVITRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-6463
(505) 609-6474
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2007006876
MO
207R00000X
Internal Medicine Physician
Primary
A-1522-09
NM
208000000X
Pediatrics Physician
2007006876
MO
208000000X
Pediatrics Physician
A-1522-09
NM
Other
Enumeration date
06/13/2007
Last updated
02/25/2025
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