Provider Demographics
NPI:1669208401
Name:LA PLATA MEDICAL EXAMINERS
Entity type:Organization
Organization Name:LA PLATA MEDICAL EXAMINERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KALCICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-556-1999
Mailing Address - Street 1:783 NEW MEXICO 170
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8700
Mailing Address - Country:US
Mailing Address - Phone:505-556-1999
Mailing Address - Fax:505-675-2788
Practice Address - Street 1:783 NEW MEXICO 170
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8700
Practice Address - Country:US
Practice Address - Phone:505-556-1999
Practice Address - Fax:505-675-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty