Healthcare Provider Details
I. General information
NPI: 1457523656
Provider Name (Legal Business Name): MAC-ELDER HILAIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 03/27/2008
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1 ABALONE LOOP MESCALERO HOSPITAL
MESCALERO NM
88340
US
IV. Provider business mailing address
1 ABALONE LOOP MESCALERO HOSPITAL
MESCALERO NM
88340
US
V. Phone/Fax
- Phone: 575-464-4441
- Fax: 575-464-4422
- Phone: 575-464-4441
- Fax: 575-464-4422
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 16729 |
| License Number State | PR |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0000X |
| Taxonomy | Adolescent Medicine (Family Medicine) Physician |
| License Number | 16729 |
| License Number State | PR |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0505X |
| Taxonomy | Adult Medicine Physician |
| License Number | 16729 |
| License Number State | PR |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: