MEDICARE: DR. EJUB CARLOS HADZIC M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	88-181	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164474797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EJUB CARLOS HADZIC M.D.

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG 1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3259
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:	575-532-7006

Provider Business Practice Location Address
First Line	:	2428 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-3512
Country	:	US
Telephone Number	:	575-234-6200
Fax Number	:	575-234-6219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/19/2010

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