Individual
KATHLEEN MEZOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 863-1820
Mailing address
1901 REDROCK DR, PFS DEPT, GALLUP, NM 87301-5683
(505) 863-7000
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
80-68
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002105
LOVELACE HEALTH/SALUD
NM
05
—
13656
—
NM
05
—
239922
—
AZ
01
—
85031326887301A131
CHAMPUS
—
01
—
NM001861
BCBS
NM
01
—
PROVP14495
MOLINA
NM
Enumeration date
02/02/2006
Last updated
07/09/2007
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