Healthcare Provider Details

I. General information

NPI: 1124418231
Provider Name (Legal Business Name): STEVEN C AUSTIN PEER SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

IV. Provider business mailing address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-2726
  • Fax:
Mailing address:
  • Phone: 505-248-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number502
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: