Healthcare Provider Details

I. General information

NPI: 1679596977
Provider Name (Legal Business Name): DAMEN MICHAEL SACOMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 JEFFERSON ST NE STE 800
ALBUQUERQUE NM
87109-2132
US

IV. Provider business mailing address

4700 JEFFERSON ST NE STE 800
ALBUQUERQUE NM
87109-2132
US

V. Phone/Fax

Practice location:
  • Phone: 505-932-7112
  • Fax:
Mailing address:
  • Phone: 505-418-6636
  • Fax: 505-521-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20050526
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: