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General NPI Number Information
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NPI Number | 1811375769
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Entity Type | Organization
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Legal Business Name | DAVID CALKINS, MD, LLC
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 117 CAMINO DE VIDA STE 300
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City | SANTA ROSA
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State | NM
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Zip | 88435-2267
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Country | US
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Telephone | 440-544-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 SOPLO RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-4422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID CALKINS
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Credential | M.D.
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Telephone | 440-544-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | MD2011-0247
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License Number State | NM
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