Provider Demographics
NPI:1104902097
Name:ALSOP, ANNA C (DOM)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:C
Last Name:ALSOP
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 HARKLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4782
Mailing Address - Country:US
Mailing Address - Phone:505-982-5156
Mailing Address - Fax:
Practice Address - Street 1:539 HARKLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4782
Practice Address - Country:US
Practice Address - Phone:505-982-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00RF99OtherBCBS