Provider Demographics
NPI:1972519759
Name:MCLEOD, ORRIN KENT (DO)
Entity Type:Individual
Prefix:
First Name:ORRIN
Middle Name:KENT
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12127B NORTH HWY 14 SUITE 5
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008
Mailing Address - Country:US
Mailing Address - Phone:505-281-2460
Mailing Address - Fax:505-281-2463
Practice Address - Street 1:12127B N HWY 14
Practice Address - Street 2:SUITE 5
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008
Practice Address - Country:US
Practice Address - Phone:505-281-2460
Practice Address - Fax:505-281-2463
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-872-88207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41178Medicaid
NM080165527OtherRAILROAD MEDICARE NUMBER
NM343331701Medicare ID - Type UnspecifiedMEDICARE NUMBER
NM41178Medicaid