Individual
DR. LAURENT GRAHAM BANNOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DHSC LN
Contact information
Practice address
3600 CERRILLOS RD, SUITE 207C, SANTA FE, NM 87507-2612
(505) 982-8475
(505) 989-7865
Mailing address
9 CERRADO DR, SANTA FE, NM 87508-8234
(505) 310-1476
(505) 982-8475
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
P-0037
NM
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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