Provider Demographics
NPI:1386607075
Name:CARREON, JESUS ROBERTO (M D)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ROBERTO
Last Name:CARREON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7229
Mailing Address - Country:US
Mailing Address - Phone:575-534-1919
Mailing Address - Fax:575-534-0135
Practice Address - Street 1:1268 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7229
Practice Address - Country:US
Practice Address - Phone:575-534-1919
Practice Address - Fax:575-534-0135
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 96-24207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43834817Medicaid
NMBC1172244OtherDEA
NM341327201Medicare PIN
NM3860750001Medicare NSC
NMBC1172244OtherDEA