Healthcare Provider Details

I. General information

NPI: 1801911698
Provider Name (Legal Business Name): DEBORAH Q SPURLOCK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PMG HIGH RESORT 4100 4100 HIGH RESORT BLVD
RIO RANCHO NM
87124
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-8800
  • Fax: 505-462-8898
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberR38418
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: