Provider Demographics
NPI:1003884602
Name:ENGSTROM, PAUL F (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 SHERRILL LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5819
Mailing Address - Country:US
Mailing Address - Phone:575-625-0123
Mailing Address - Fax:575-625-0131
Practice Address - Street 1:342 SHERRILL LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5819
Practice Address - Country:US
Practice Address - Phone:575-625-0123
Practice Address - Fax:575-625-0131
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-181207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009129OtherBCBS
NMP00344526OtherRAILROAD MEDICARE PIN
NM12313OtherCIDC
NMB3625Medicaid
NM76-0161899OtherFED TAX ID
NMNM009129OtherBCBS
NM20-4244692OtherEIN
NMB3625Medicaid