Healthcare Provider Details

I. General information

NPI: 1528078938
Provider Name (Legal Business Name): SCOTT W MCMAHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N MAIN ST
ROSWELL NM
88201-4725
US

IV. Provider business mailing address

PO BOX 711
ROSWELL NM
88202-0711
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-2095
  • Fax: 575-208-0780
Mailing address:
  • Phone: 575-624-2095
  • Fax: 575-208-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number92-302
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number92-302
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: