Healthcare Provider Details

I. General information

NPI: 1386803864
Provider Name (Legal Business Name): DON W HEDGES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6463 4TH ST NW
ALBUQUERQUE NM
87107-5810
US

IV. Provider business mailing address

6463 4TH ST NW
ALBUQUERQUE NM
87107-5810
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-3572
  • Fax: 505-345-5889
Mailing address:
  • Phone: 505-345-3572
  • Fax: 505-345-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA-624-74
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: