Baca, Jerome Wayne

Baca, Jerome Wayne is an individual health care provider with primary practice located at 6701 Jefferson St Ne , Albuquerque NM 87109. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Baca, Jerome Wayne can be contacted via phone (505) 727-6200.

Contact Information

Primary practice address
6701 Jefferson St Ne Albuquerque NM 87109
Phone: (505) 727-6200
Fax: (505) 727-9590
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA2012-0025 New Mexico

Profile Details

NPI number 1811243462
LBN Legal business name Baca, Jerome Wayne
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2012
Last updated Nov 7th, 2019 - about 7 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 1811243462 NPPES
New Mexico MEDICAID 64471870
New Mexico Other PA2012-0025

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