Healthcare Provider Details

I. General information

NPI: 1811941149
Provider Name (Legal Business Name): MARGARET MARY WESTERN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E OLIVE ST
DEMING NM
88030-4747
US

IV. Provider business mailing address

301 WANDA ST
MARIETTA OK
73448-1229
US

V. Phone/Fax

Practice location:
  • Phone: 575-544-8209
  • Fax: 575-546-7408
Mailing address:
  • Phone: 580-276-2400
  • Fax: 580-276-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2005-0767
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31055
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: