Individual
DR. ALLEN WILSON MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 E 30TH, BLDG B SUITE 106, FARMINGTON, NM 87401
(505) 327-9111
(505) 327-2730
Mailing address
PO BOX 1529, 2300 E 30TH BLDG B SUITE 106, FARMINGTON, NM 87401
(505) 327-9111
(505) 327-2730
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
87 115
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11338
—
NM
Enumeration date
10/24/2006
Last updated
06/18/2013
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