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General NPI Number Information
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NPI Number | 1053621060
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Entity Type | Organization
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Legal Business Name | MASOUD KHORSAND-SAHBAIE, MD PA
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 3028 N. GRIMES
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City | HOBBS
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State | NM
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Zip | 88241
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Country | US
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Telephone | 575-392-0222
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Fax | 575-392-0200
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Provider Business Mailing Address
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Address Line | PO BOX 1574
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City | ROSWELL
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State | NM
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Zip | 88202-1574
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Country | US
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Telephone | 575-627-9505
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Fax | 877-749-7764
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Authorized Official
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Title or Position | BUSINESS SYSTEMS/CREDENTIALING MGR
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Name | BRENDA COTTRELL
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Credential |
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Telephone | 575-627-9508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 96299
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD2012-0091
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License Number State | NM
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