Healthcare Provider Details

I. General information

NPI: 1861473027
Provider Name (Legal Business Name): ALTAF AHMED MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 E LOHMAN AVE
LAS CRUCES NM
88011-8267
US

IV. Provider business mailing address

PO BOX 15009
LAS CRUCES NM
88004-5009
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-0133
  • Fax: 575-233-6323
Mailing address:
  • Phone: 505-400-0133
  • Fax: 575-233-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALTAF AHMED
Title or Position: OWNER
Credential: MD
Phone: 505-400-0133