Healthcare Provider Details

I. General information

NPI: 1669412771
Provider Name (Legal Business Name): STEVEN C EYRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

PO BOX 2505
SALEM OR
97308-2505
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-3361
  • Fax:
Mailing address:
  • Phone: 888-828-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76-166
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: