Provider Demographics
NPI:1043356561
Name:SECORA, CHARLES LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LESLIE
Last Name:SECORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2014 GWENDA DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-9680
Mailing Address - Country:US
Mailing Address - Phone:505-887-2989
Mailing Address - Fax:505-887-2989
Practice Address - Street 1:166 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2002
Practice Address - Country:US
Practice Address - Phone:505-445-4111
Practice Address - Fax:505-445-2666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology