Provider Demographics
NPI:1205912441
Name:MUELLER, SANDRA MARIE (MD PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MD PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:640 QUANTUM RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-924-0209
Mailing Address - Fax:505-924-0210
Practice Address - Street 1:PETROGLYPH PATHOLOGY SERVICES LLC
Practice Address - Street 2:1207B GOLF COURSE RD SE
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-924-0209
Practice Address - Fax:505-924-0210
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM20020204207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13826085Medicaid
NM500521051Medicare ID - Type Unspecified
NM13826085Medicaid