Healthcare Provider Details

I. General information

NPI: 1366630634
Provider Name (Legal Business Name): JAMES H AUERBACH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR BLDG A SUITE 101
SANTA FE NM
87505-7672
US

IV. Provider business mailing address

435 SAINT MICHAELS DR BLDG A SUITE 101
SANTA FE NM
87505-7672
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-5504
  • Fax: 505-982-2390
Mailing address:
  • Phone: 505-982-5504
  • Fax: 505-982-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number76-5
License Number StateNM

VIII. Authorized Official

Name: DR. JAMES H AUERBACH
Title or Position: OWNER
Credential: MD
Phone: 505-982-5504