Healthcare Provider Details

I. General information

NPI: 1033752357
Provider Name (Legal Business Name): DANIEL RAY SPOHN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 RIO RANCHO DR SE
RIO RANCHO NM
87124-1587
US

IV. Provider business mailing address

6205 COCHITI DR NW
ALBUQUERQUE NM
87120-4487
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-5520
  • Fax:
Mailing address:
  • Phone: 505-401-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2019-0097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: