Healthcare Provider Details

I. General information

NPI: 1871906974
Provider Name (Legal Business Name): CATHERINE LEE CANTWAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

PO BOX 881840
STEAMBOAT SPRINGS CO
80488-1840
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2000
  • Fax:
Mailing address:
  • Phone: 970-875-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-1368
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCDRH.0056975
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberDR.0056975
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number10290332-1205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberCDRH.0056975
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: