Provider Demographics
NPI:1770680902
Name:TONCRAY, JENNIFER L (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:TONCRAY
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 1:1212 9TH STREET
Mailing Address - Street 2:SUITE A TULAROSA BASIN DERMATOLOGY
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:505-437-6700
Mailing Address - Fax:505-437-6644
Practice Address - Street 1:1212 9TH STREET
Practice Address - Street 2:SUITE H TULAROSA BASIN DERMATOLOGY
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:505-437-6700
Practice Address - Fax:505-437-6644
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA115701207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G85226Medicare UPIN