Provider Demographics
NPI:1356534317
Name:CATE, MARY RAY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RAY
Last Name:CATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:111 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2627
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5815
Practice Address - Street 1:1235 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4219
Practice Address - Country:US
Practice Address - Phone:505-425-6788
Practice Address - Fax:505-425-5408
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM79-18208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00032458Medicaid