Provider Demographics
NPI:1982656948
Name:GAULT-MCNEMEE, DOROTHY F (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:F
Last Name:GAULT-MCNEMEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1590
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-1590
Mailing Address - Country:US
Mailing Address - Phone:505-589-1144
Mailing Address - Fax:505-589-2008
Practice Address - Street 1:5290 MCNUTT ROAD
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-1590
Practice Address - Country:US
Practice Address - Phone:505-589-1144
Practice Address - Fax:505-589-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMMD81200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4536409OtherAETNA
NMNM001020OtherBLUE CROSS BLUE SHIELD
C97778Medicare UPIN