Healthcare Provider Details

I. General information

NPI: 1437158003
Provider Name (Legal Business Name): CHARLES ANTHONY DOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 E LOHMAN AVE
LAS CRUCES NM
88011-8267
US

IV. Provider business mailing address

4407 E LOHMAN AVE
LAS CRUCES NM
88011-8267
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-6806
  • Fax: 575-521-8033
Mailing address:
  • Phone: 575-522-6806
  • Fax: 575-521-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number91-35
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: