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General NPI Number Information
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NPI Number | 1780605923
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Entity Type | Individual
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Provider Name | DAVID BENNAHUM MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WESTSIDE FAMILY / SENIOR HEALTH CENTER 4808 MC MAHON BLVD.
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City | ALBUQUERQUE
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State | NM
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Zip | 87114
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Country | US
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Telephone | 505-272-1754
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Fax |
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Provider Business Mailing Address
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Address Line | 4808 MCMAHON BLVD NW MSC10 5550
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5010
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Country | US
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Telephone | 505-272-1754
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 70-13
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License Number State | NM
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