Provider Demographics
NPI:1851794127
Name:MARKETTO ANESTHESIA LLC
Entity Type:Organization
Organization Name:MARKETTO ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARKETTO
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:575-532-7000
Mailing Address - Street 1:205 W BOUTZ RD
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3262
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:575-532-7111
Practice Address - Street 1:205 W BOUTZ RD
Practice Address - Street 2:BLDG #1
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3262
Practice Address - Country:US
Practice Address - Phone:575-532-7000
Practice Address - Fax:575-532-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-101794207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty