Provider Demographics
NPI:1932261831
Name:MACFARLANE, JOHN ALAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:MACFARLANE
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 1:630 PASEO DEL PUEBLO SUR STE 150
Mailing Address - Street 2:BOX 5436 NDCBU
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7002
Mailing Address - Country:US
Mailing Address - Phone:575-758-3005
Mailing Address - Fax:
Practice Address - Street 1:630 PASEO DEL PUEBLO SUR STE 150
Practice Address - Street 2:BOX 5436 NDCBU
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7002
Practice Address - Country:US
Practice Address - Phone:575-758-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1356208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAA1356OtherSTATE LICENSE
AKAA1356OtherSTATE LICENSE
AM7023865OtherDEA NUMBER