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General NPI Number Information
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NPI Number | 1710176995
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Entity Type | Organization
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Legal Business Name | SOUTHWEST OBSTETRICS AND GYNECOLOGY, LLC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 634 W PINON ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5915
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Country | US
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Telephone | 505-325-4898
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Fax | 505-325-7898
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Provider Business Mailing Address
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Address Line | 634 W PINON ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5915
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Country | US
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Telephone | 505-325-4898
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Fax | 505-325-7898
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ALLEN FISHER
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Credential | MD
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Telephone | 505-325-4898
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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 | MD2007-0662
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License Number State | NM
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