NPI 1023527314
Justin R Ennis
Practice location
- Address
- 1500 S Avenue K, Portales, NM 88130-7400
- Phone
- (760) 525-2087
- Mailing address
- 1500 S Avenue K # 17, Portales, NM 88130-7400
Registered specialties
Sports Medicine (Emergency Medicine) Physician
Primary
Registry record
- NPI
- 1023527314
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 29 Sep 2017
- Record last updated
- 29 Sep 2017
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.