Provider Demographics
NPI:1639183122
Name:SAND, CARLA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:SAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3688
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:NM
Mailing Address - Zip Code:87021-3688
Mailing Address - Country:US
Mailing Address - Phone:541-224-4077
Mailing Address - Fax:
Practice Address - Street 1:3 NAVARRE BLVD
Practice Address - Street 2:THOREAU CLINIC
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313
Practice Address - Country:US
Practice Address - Phone:505-786-5291
Practice Address - Fax:505-786-6440
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD-2013-0924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine