Healthcare Provider Details

I. General information

NPI: 1891861597
Provider Name (Legal Business Name): DOUGLAS HINTEN EMCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

5312 JAGUAR DR
SANTA FE NM
87507-1827
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-2727
  • Fax:
Mailing address:
  • Phone: 505-820-0262
  • Fax: 505-820-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2006-0643
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: