Healthcare Provider Details

I. General information

NPI: 1932148384
Provider Name (Legal Business Name): CONSTANCE DAPHNE WASH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S ROADRUNNER PKWY
LAS CRUCES NM
88011-7044
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 505-556-8600
  • Fax: 505-556-8700
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-437-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2001-330
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: