Van Wormer, Mark Edward

Van Wormer, Mark Edward is an individual health care provider with primary practice located at 314 N 3Rd Ave , Clayton NM 88415-3302. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Van Wormer, Mark Edward can be contacted via phone (575) 374-8313.

Contact Information

Primary practice address
314 N 3Rd Ave Clayton NM 88415-3302
Phone: (575) 374-8313
Fax: (575) 374-2064
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 81333 New Mexico

Profile Details

NPI number 1013919034
LBN Legal business name Van Wormer, Mark Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Jul 15th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013919034 NPPES
Other 060000475 RAILROAD MEDICARE
MEDICAID 05645 RAILROAD MEDICARE

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