Healthcare Provider Details

I. General information

NPI: 1528040268
Provider Name (Legal Business Name): NICHOLAS J ROWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COMMERCE WAY STE 104
CLOVIS NM
88101-4775
US

IV. Provider business mailing address

201 COMMERCE WAY STE 104
CLOVIS NM
88101-4775
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-3385
  • Fax: 575-762-3386
Mailing address:
  • Phone: 575-762-3385
  • Fax: 575-762-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number76258
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number76258
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: