Provider Demographics
NPI:1578675765
Name:ADAY, DAVID BRENT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRENT
Last Name:ADAY
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 1:1410 ASPEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:505-437-7000
Mailing Address - Fax:575-434-6288
Practice Address - Street 1:1410 ASPEN DRIVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-437-7000
Practice Address - Fax:575-434-6288
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01016Medicaid
NM01016Medicaid