Healthcare Provider Details

I. General information

NPI: 1679875926
Provider Name (Legal Business Name): OKAY HAROLD ODOCHA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E 32ND ST STE A
SILVER CITY NM
88061-7215
US

IV. Provider business mailing address

1302 E 32ND ST STE A
SILVER CITY NM
88061-7215
US

V. Phone/Fax

Practice location:
  • Phone: 575-956-6633
  • Fax: 575-956-6615
Mailing address:
  • Phone: 575-956-6633
  • Fax: 575-956-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD2009-0004
License Number StateNM

VIII. Authorized Official

Name: DR. OKAY HAROLD ODOCHA
Title or Position: OWNER
Credential: MD
Phone: 575-956-6633