Healthcare Provider Details

I. General information

NPI: 1386675270
Provider Name (Legal Business Name): GREGORY ALAN CHARLTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S TELSHOR BLVD SUITE B
LAS CRUCES NM
88011-4731
US

IV. Provider business mailing address

1240 S TELSHOR BLVD SUITE B
LAS CRUCES NM
88011-4731
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-3885
  • Fax: 575-522-3895
Mailing address:
  • Phone: 575-522-3885
  • Fax: 575-522-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2001-154
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2001-154
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number2001-154
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: