Healthcare Provider Details

I. General information

NPI: 1457445942
Provider Name (Legal Business Name): SOUTHWESTERN HEARING CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR STE B104
SANTA FE NM
87505-7671
US

IV. Provider business mailing address

435 SAINT MICHAELS DR STE B104
SANTA FE NM
87505-7671
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-3955
  • Fax: 505-982-2996
Mailing address:
  • Phone: 505-946-3955
  • Fax: 505-982-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. DAVID R. BROWN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 505-982-4848