Healthcare Provider Details

I. General information

NPI: 1932187044
Provider Name (Legal Business Name): MASOUD KHORSAND- SAHBAIE MD P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MILITARY HEIGHTS PL
ROSWELL NM
88201-6407
US

IV. Provider business mailing address

PO BOX 1574
ROSWELL NM
88202-1574
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-9500
  • Fax: 877-749-7764
Mailing address:
  • Phone: 575-627-9508
  • Fax: 877-749-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberST96299
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD2007-0020
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD2011-0742
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2012-0244
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number96299
License Number StateNM

VIII. Authorized Official

Name: DR. MASOUD KHORSAND-SAHBAIE
Title or Position: OWNER
Credential: MD
Phone: 575-627-9110