Healthcare Provider Details

I. General information

NPI: 1770529380
Provider Name (Legal Business Name): ANDRE J HUFFMIRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 CALLE CONTENTA
CORRALES NM
87048-9065
US

IV. Provider business mailing address

PO BOX 1237
CORRALES NM
87048-1237
US

V. Phone/Fax

Practice location:
  • Phone: 970-629-2489
  • Fax:
Mailing address:
  • Phone: 970-629-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23974
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80-45
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: