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General NPI Number Information
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NPI Number | 1801015664
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Entity Type | Organization
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Legal Business Name | HIGH DESERT HEMATOLOGY ONCOLOGY PC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 460 SAINT MICHAELS DR SUITE 1204
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City | SANTA FE
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State | NM
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Zip | 87505-7619
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Country | US
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Telephone | 505-983-4898
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Fax |
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Provider Business Mailing Address
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Address Line | 460 SAINT MICHAELS DR SUITE 1204
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City | SANTA FE
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State | NM
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Zip | 87505-7619
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Country | US
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Telephone | 801-560-1566
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAURY BLITMAN
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Credential | MD
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Telephone | 505-983-4898
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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 | 2003-0406
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License Number State | NM
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