Healthcare Provider Details

I. General information

NPI: 1811644933
Provider Name (Legal Business Name): RUSSELL CANFIELD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 AVENIDA ALDEA
SANTA FE NM
87507-9449
US

IV. Provider business mailing address

66 AVENIDA ALDEA
SANTA FE NM
87507-9449
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-7111
  • Fax: 505-795-7112
Mailing address:
  • Phone: 505-795-7111
  • Fax: 505-795-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE RUSSELL CANFIELD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 505-795-7111