Healthcare Provider Details

I. General information

NPI: 1477765550
Provider Name (Legal Business Name): BENJAMIN DOWNIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 DILLON RD
CLOVIS NM
88101-9454
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7365
  • Fax: 575-769-7120
Mailing address:
  • Phone: 575-769-7365
  • Fax: 575-769-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD2024-0722
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberN6268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: