Provider Demographics
NPI:1598187767
Name:HAMID, AHSAN
Entity Type:Individual
Prefix:
First Name:AHSAN
Middle Name:
Last Name:HAMID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 FOOTHILLS RD STE N
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-3621
Mailing Address - Country:US
Mailing Address - Phone:575-532-6054
Mailing Address - Fax:575-532-0215
Practice Address - Street 1:3530 FOOTHILLS RD STE N
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3621
Practice Address - Country:US
Practice Address - Phone:575-532-6054
Practice Address - Fax:575-532-0215
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant