Healthcare Provider Details

I. General information

NPI: 1770858102
Provider Name (Legal Business Name): IAN POWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

IV. Provider business mailing address

2300 E 30TH ST BLDG D-101
FARMINGTON NM
87401-8991
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax: 505-338-0034
Mailing address:
  • Phone: 505-327-1400
  • Fax: 505-564-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2018-0254
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: