Provider Demographics
NPI:1942251434
Name:NEW MEXICO BONE AND JOINT INSTITUTE PC
Entity Type:Organization
Organization Name:NEW MEXICO BONE AND JOINT INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-434-0639
Mailing Address - Street 1:2301 INDIAN WELLS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4607
Mailing Address - Country:US
Mailing Address - Phone:575-434-0639
Mailing Address - Fax:575-434-4148
Practice Address - Street 1:2301 INDIAN WELLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4607
Practice Address - Country:US
Practice Address - Phone:575-434-0639
Practice Address - Fax:575-434-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0600004410174400000X
NM284213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML1222Medicaid
NM400521106Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NM1020410001Medicare NSC