Provider Demographics
NPI:1043730799
Name:M DOUGLAS SEFCIK DPM LLC
Entity Type:Organization
Organization Name:M DOUGLAS SEFCIK DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SEFCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:575-526-6103
Mailing Address - Street 1:1135 N SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2349
Mailing Address - Country:US
Mailing Address - Phone:575-526-6103
Mailing Address - Fax:575-526-6347
Practice Address - Street 1:1135 N SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2349
Practice Address - Country:US
Practice Address - Phone:575-526-6103
Practice Address - Fax:575-526-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM372213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty