MEDICARE: SUSAN FAYTHE GOWING P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	78-PA003	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528064060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FAYTHE GOWING P.A.

Provider Business Mailing Address
First Line	:	1923 WINDSOR PL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1683
Country	:	US
Telephone Number	:	575-312-9077
Fax Number	:	575-647-2938

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE
Second Line	:	SUITE 405
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8259
Country	:	US
Telephone Number	:	575-521-0121
Fax Number	:	575-532-5949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	10/17/2007

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