Healthcare Provider Details

I. General information

NPI: 1023096096
Provider Name (Legal Business Name): AZIM SAQUIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MALL DR
LAS CRUCES NM
88011-8128
US

IV. Provider business mailing address

PO BOX 6310
LAS CRUCES NM
88006-6310
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3270
  • Fax:
Mailing address:
  • Phone: 575-521-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036114868
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2013-0055
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: