Provider Demographics
NPI:1093829400
Name:FONSECA, JESUS J (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:J
Last Name:FONSECA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2830
Mailing Address - Country:US
Mailing Address - Phone:575-396-6611
Mailing Address - Fax:575-396-1454
Practice Address - Street 1:1923 N. DAL PASO, SUITE A
Practice Address - Street 2:HOBBS MEDICAL CLINIC
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3023
Practice Address - Country:US
Practice Address - Phone:575-433-3000
Practice Address - Fax:575-433-4451
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG2204Medicaid
NM541264YNGGMedicare Oscar/Certification
NMF95520Medicare UPIN