Healthcare Provider Details

I. General information

NPI: 1831297209
Provider Name (Legal Business Name): BISHNU RAUTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 209
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY ATTNT: CREDENTIALING DEPARTMENT
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-5944
  • Fax: 505-522-0636
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-810-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number91288
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: