Healthcare Provider Details
I. General information
NPI: 1992005573
Provider Name (Legal Business Name): HAROLD E ALEXANDER JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
741 N ALAMEDA BLVD STE 3
LAS CRUCES NM
88005-2172
US
IV. Provider business mailing address
205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US
V. Phone/Fax
- Phone: 575-522-0399
- Fax: 575-522-1866
- Phone: 575-532-7000
- Fax: 575-532-7000
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 84-3 |
| License Number State | NM |
VIII. Authorized Official
Name:
HAROLD
E
ALEXANDER
JR.
Title or Position: OWNER
Credential: MD
Phone: 575-522-0399