Provider Demographics
NPI:1003116922
Name:BABCOCK PIERCE, JENNIFER LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:BABCOCK PIERCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LOUISE
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 W ALAMEDA ST STE 25
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1673
Mailing Address - Country:US
Mailing Address - Phone:505-988-8869
Mailing Address - Fax:505-982-7321
Practice Address - Street 1:901 W ALAMEDA ST STE 25
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1673
Practice Address - Country:US
Practice Address - Phone:505-988-8869
Practice Address - Fax:505-982-7321
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine