Basic Information
| Provider Information | |||||||||
| NPI: | 1457381394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEAGAN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6210 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874996210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056092258 | ||||||||
| FaxNumber: | 5056092259 | ||||||||
| Practice Location | |||||||||
| Address1: | 1135 S MAIN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880052946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755254000 | ||||||||
| FaxNumber: | 5755254040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 328128 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 25MB07815200 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | MB07815200 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QG0300X | A-1549-10 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 48328286 | 05 | NM | MEDICAID |