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General NPI Number Information
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NPI Number | 1043356561
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Entity Type | Individual
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Provider Name | CHARLES LESLIE SECORA MD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 166 HOSPITAL DR
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City | RATON
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State | NM
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Zip | 87740-2002
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Country | US
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Telephone | 505-445-4111
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Fax | 505-445-2666
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Provider Business Mailing Address
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Address Line | 2014 GWENDA DR
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City | CARLSBAD
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State | NM
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Zip | 88220-9680
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Country | US
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Telephone | 505-887-2989
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Fax | 505-887-2989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 89-298
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License Number State | NM
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