Healthcare Provider Details

I. General information

NPI: 1912917485
Provider Name (Legal Business Name): DONALD D. HARVILLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7656
US

IV. Provider business mailing address

8200 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7656
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4414
  • Fax: 505-299-4513
Mailing address:
  • Phone: 505-299-4414
  • Fax: 505-299-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number65-34
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: