Provider Demographics
NPI:1235172842
Name:KANDEL, JOAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:E
Last Name:KANDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:DULCE
Mailing Address - State:NM
Mailing Address - Zip Code:87528-0649
Mailing Address - Country:US
Mailing Address - Phone:505-360-5995
Mailing Address - Fax:
Practice Address - Street 1:90 MEDICINE WAY
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528
Practice Address - Country:US
Practice Address - Phone:505-360-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2282-19207Q00000X
AZ3986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ764846Medicaid
8EZ39NMedicare ID - Type Unspecified
AZ764846Medicaid