Healthcare Provider Details

I. General information

NPI: 1508186784
Provider Name (Legal Business Name): TIMOTHY MICHAEL ERWIN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE STE 150
ALBUQUERQUE NM
87109-5888
US

IV. Provider business mailing address

4411 THE 25 WAY NE STE 150
ALBUQUERQUE NM
87109-5888
US

V. Phone/Fax

Practice location:
  • Phone: 505-332-5800
  • Fax:
Mailing address:
  • Phone: 505-332-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2016-0183
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: