Healthcare Provider Details

I. General information

NPI: 1821276775
Provider Name (Legal Business Name): DAVID N EWING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 ROMA AVE NE
ALBUQUERQUE NM
87106-4514
US

IV. Provider business mailing address

1621 ROMA AVE NE
ALBUQUERQUE NM
87106-4514
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-6002
  • Fax:
Mailing address:
  • Phone: 505-401-5053
  • Fax: 505-672-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number91-43
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: