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General NPI Number Information
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NPI Number | 1255688271
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Entity Type | Individual
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Provider Name | AHMAD H OTHMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 233 FAIRWAY TER N STE B
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City | CLOVIS
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State | NM
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Zip | 88101-3060
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Country | US
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Telephone | 575-762-7779
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Fax | 575-762-3526
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Provider Business Mailing Address
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Address Line | 2508 FAIRWAY TER
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City | CLOVIS
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State | NM
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Zip | 88101-2734
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Country | US
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Telephone | 312-813-6958
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2018-0173
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License Number State | NM
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