Healthcare Provider Details

I. General information

NPI: 1033163373
Provider Name (Legal Business Name): LONNIE DAVID ALEXANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W. 21ST STREET STE A-1
CLOVIS NM
88101
US

IV. Provider business mailing address

2000 W. 21ST STREET STE A-1
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-8055
  • Fax: 575-763-3351
Mailing address:
  • Phone: 575-762-8055
  • Fax: 575-763-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86-003
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number86-003
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: