Provider Demographics
NPI:1801853312
Name:BJORKMAN, PER G (MD)
Entity Type:Individual
Prefix:
First Name:PER
Middle Name:G
Last Name:BJORKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 WEIMER ROAD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-8833
Mailing Address - Fax:575-751-5718
Practice Address - Street 1:1397 WEIMER ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-8833
Practice Address - Fax:575-751-5718
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-04-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-04-11
Provider Licenses
StateLicense IDTaxonomies
NM9617207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68651Medicaid
H001301059Medicare PIN
E57484Medicare UPIN