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General NPI Number Information
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NPI Number | 1679576565
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Entity Type | Individual
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Provider Name | ENOCH ECHEZONA AGUNANNE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 311 W COUNTRY CLUB RD STE 1
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City | ROSWELL
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State | NM
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Zip | 88201-5839
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Country | US
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Telephone | 575-625-3400
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Fax | 575-625-3415
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Provider Business Mailing Address
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Address Line | 311 W COUNTRY CLUB RD STE 1
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City | ROSWELL
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State | NM
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Zip | 88201-5839
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Country | US
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Telephone | 575-625-3400
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Fax | 575-625-3415
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | L6755
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License Number State | TX
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