Healthcare Provider Details

I. General information

NPI: 1275575383
Provider Name (Legal Business Name): TIMOTHY W FROST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 10TH ST SUITE 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: 505-437-4533
  • Fax: 505-437-5009
Mailing address:
  • Phone: 505-437-4533
  • Fax: 505-437-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number93260
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: