Healthcare Provider Details

I. General information

NPI: 1679576565
Provider Name (Legal Business Name): ENOCH ECHEZONA AGUNANNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W COUNTRY CLUB RD STE 1
ROSWELL NM
88201-5839
US

IV. Provider business mailing address

311 W COUNTRY CLUB RD STE 1
ROSWELL NM
88201-5839
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-3400
  • Fax: 575-625-3415
Mailing address:
  • Phone: 575-625-3400
  • Fax: 575-625-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL6755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: