Provider Demographics
NPI:1417153537
Name:MASHBURN, JOSEPH PATTON
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATTON
Last Name:MASHBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ELENA CIR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7711
Mailing Address - Country:US
Mailing Address - Phone:505-867-2383
Mailing Address - Fax:505-867-7293
Practice Address - Street 1:872 S CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5927
Practice Address - Country:US
Practice Address - Phone:505-867-2383
Practice Address - Fax:505-867-7293
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator