Provider Demographics
NPI:1346299096
Name:STALKER, DAVID ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEX
Last Name:STALKER
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:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-0833
Mailing Address - Country:US
Mailing Address - Phone:575-762-7779
Mailing Address - Fax:575-762-3526
Practice Address - Street 1:233 FAIRWAY TER N STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-762-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87-389208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10002070OtherLOVELACE HEALTH SYSTEM
NME9226Medicaid
NM128595101OtherSOUTHWEST LIFE & HEALTH
NMNM009Y93OtherBLUE CROSS/BLUE SHIELD
NM343612507Medicare PIN
NM128595101OtherSOUTHWEST LIFE & HEALTH
NME56234Medicare UPIN