Healthcare Provider Details

I. General information

NPI: 1699735100
Provider Name (Legal Business Name): DAVID L HEMPHILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 CORRALES RD STE 2
CORRALES NM
87048-8663
US

IV. Provider business mailing address

4313 CORRALES RD STE 2
CORRALES NM
87048-8663
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-5544
  • Fax: 833-974-2306
Mailing address:
  • Phone: 505-400-5544
  • Fax: 833-974-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20040714
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD20040714
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: