Healthcare Provider Details

I. General information

NPI: 1043207285
Provider Name (Legal Business Name): DAVID N EWING MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-6002
  • Fax:
Mailing address:
  • Phone: 505-255-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9143
License Number StateNM

VIII. Authorized Official

Name: DAVID N EWING
Title or Position: PRESIDENT
Credential: MD
Phone: 505-255-6002