Provider Demographics
NPI:1922045319
Name:DJRJ3 MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:DJRJ3 MEDICAL SERVICES INC
Other - Org Name:DJRJ2
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:505-404-9132
Mailing Address - Street 1:PO BOX 7191
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-7191
Mailing Address - Country:US
Mailing Address - Phone:505-404-9132
Mailing Address - Fax:505-393-1076
Practice Address - Street 1:840 LOBO CANYON RD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2172
Practice Address - Country:US
Practice Address - Phone:505-404-9132
Practice Address - Fax:505-393-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0395207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274840100Medicaid
FL10-8990OtherRURAL HEALTH CLINIC PROVI
FL660226600Medicaid
NM80574271Medicaid