Healthcare Provider Details

I. General information

NPI: 1801015664
Provider Name (Legal Business Name): HIGH DESERT HEMATOLOGY ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR SUITE 1204
SANTA FE NM
87505-7619
US

IV. Provider business mailing address

460 SAINT MICHAELS DR SUITE 1204
SANTA FE NM
87505-7619
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-4898
  • Fax:
Mailing address:
  • Phone: 801-560-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2003-0406
License Number StateNM

VIII. Authorized Official

Name: MAURY BLITMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-983-4898