Healthcare Provider Details

I. General information

NPI: 1679242457
Provider Name (Legal Business Name): SEEBERGER DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 10TH ST STE C
ALAMOGORDO NM
88310-5012
US

IV. Provider business mailing address

1401 10TH ST STE C
ALAMOGORDO NM
88310-5012
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-9886
  • Fax:
Mailing address:
  • Phone: 575-437-4533
  • Fax: 575-437-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BONN SEEBERGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 434-841-8300