Healthcare Provider Details

I. General information

NPI: 1164474797
Provider Name (Legal Business Name): EJUB CARLOS HADZIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 W PIERCE ST
CARLSBAD NM
88220-3512
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-234-6200
  • Fax: 575-234-6219
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number88-181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: