Provider Demographics
NPI:1275590556
Name:CARDASIS, JAMES P (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:CARDASIS
Suffix:
Gender:M
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 2530
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-2530
Mailing Address - Country:US
Mailing Address - Phone:505-758-4287
Mailing Address - Fax:
Practice Address - Street 1:619 DON ROSALIO
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-942-91207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP12107OtherMOLINA SALUD
NMNM01400AOtherBCBS
NM201001447OtherPHP
NM21325OtherLHP
NME2321Medicaid
NMNM01400AOtherBCBS
B07368Medicare UPIN