1427108083 NPI number — MR. E DOW SUHRE MD

Table of content: MR. E DOW SUHRE MD (NPI 1427108083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427108083 NPI number — MR. E DOW SUHRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUHRE
Provider First Name:
E
Provider Middle Name:
DOW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427108083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 SAINT MICHAELS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-820-5227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 SAINT MICHAELS DR
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-7670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-984-2600
Provider Business Practice Location Address Fax Number:
505-983-7299
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  47652 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 7496 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 47652 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 7496 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16004 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7496 . This is a "NEW MEXICO LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM002A16 . This is a "BCBS NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 01131 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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