Basic Information
Provider Information
NPI: 1003143918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DRUMMOND
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 26666
Address2: PHS PROVIDER ENROLLMENT
City: ALBUQUERQUE
State: NM
PostalCode: 871256666
CountryCode: US
TelephoneNumber: 5059236770
FaxNumber:  
Practice Location
Address1: 1010 SPRUCE ST
Address2:  
City: ESPANOLA
State: NM
PostalCode: 875322724
CountryCode: US
TelephoneNumber: 5057537111
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/13/2009
LastUpdateDate: 06/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XA-1944-16NMY Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X34.010921OHN Allopathic & Osteopathic PhysiciansEmergency Medicine 
208D00000X58.003350OHN Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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