Healthcare Provider Details

I. General information

NPI: 1043730799
Provider Name (Legal Business Name): M DOUGLAS SEFCIK DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 N SOLANO DR
LAS CRUCES NM
88001-2349
US

IV. Provider business mailing address

1135 N SOLANO DR
LAS CRUCES NM
88001-2349
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-6103
  • Fax: 575-526-6347
Mailing address:
  • Phone: 575-526-6103
  • Fax: 575-526-6347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number372
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DOUGLAS SEFCIK
Title or Position: OWNER
Credential: DPM
Phone: 575-526-6103