Healthcare Provider Details

I. General information

NPI: 1629066097
Provider Name (Legal Business Name): MASOUD KHORSAND-SAHBAIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W COUNTRY CLUB RD
ROSWELL NM
88201-5209
US

IV. Provider business mailing address

PO BOX 1574
ROSWELL NM
88202-1574
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-9110
  • Fax: 575-627-9535
Mailing address:
  • Phone: 575-627-9500
  • Fax: 575-627-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number96299
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: