Individual
JEREMY TODD EDMONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1108 CENTRAL AVE SW, MORIARTY, NM 87035-1520
(505) 832-4434
(505) 832-5024
Mailing address
PO BOX 1520, MORIARTY, NM 87035-1520
(505) 832-4434
(505) 832-5024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A-1270-04
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080165527
RAILROAD MEDICARE NUMBER
NM
05
—
30827850
—
NM
Enumeration date
08/01/2006
Last updated
07/09/2007
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