Healthcare Provider Details

I. General information

NPI: 1447430509
Provider Name (Legal Business Name): ROSWELL EAR, NOSE & THROAT & ALLERGY L. L. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 SHERRILL LN STE A
ROSWELL NM
88201-5831
US

IV. Provider business mailing address

342 SHERRILL LN STE A
ROSWELL NM
88201-5831
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-2911
  • Fax: 575-622-2598
Mailing address:
  • Phone: 575-622-2911
  • Fax: 575-622-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCS00208445
License Number StateNM

VIII. Authorized Official

Name: DR. JAN D. HOBBS
Title or Position: OWNER
Credential: M.D.
Phone: 575-622-2911