Provider Demographics
NPI:1194797779
Name:MACIAS, DARRYL (MD)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Practice Address - Street 2:1901 RED ROCK DRIVE
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-319207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201006171OtherPRESBYTERIAN HEALTH/SALUD
P00200863OtherRAILROAD MEDICARE
NMPROVP14220OtherMOLINA
NMNM007580OtherBCBS
NM16592Medicaid
NM10001036OtherLOVELACE HEALTH/SALUD
AZ176207Medicaid
F85876Medicare UPIN
NM16592Medicaid
344503801Medicare ID - Type Unspecified