Provider Demographics
NPI:1003362807
Name:NEW MEXICO BONE AND JOINT INSTITUTE PC
Entity Type:Organization
Organization Name:NEW MEXICO BONE AND JOINT INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-434-0639
Mailing Address - Street 1:2301 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4611
Mailing Address - Country:US
Mailing Address - Phone:575-434-0639
Mailing Address - Fax:575-434-4148
Practice Address - Street 1:2951 N ROADRUNNER PKWY
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-0814
Practice Address - Country:US
Practice Address - Phone:575-526-6515
Practice Address - Fax:575-526-6531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW MEXICO BONE AND JOINT INSTITUTE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-31
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000L1222Medicaid
NM000L1222Medicaid
NM1020410001Medicare NSC