Provider Demographics
NPI:1801015664
Name:HIGH DESERT HEMATOLOGY ONCOLOGY PC
Entity Type:Organization
Organization Name:HIGH DESERT HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-983-4898
Mailing Address - Street 1:460 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7619
Mailing Address - Country:US
Mailing Address - Phone:801-560-1566
Mailing Address - Fax:
Practice Address - Street 1:460 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 1204
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7619
Practice Address - Country:US
Practice Address - Phone:505-983-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0406207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1396713095OtherINDIVIDUAL NPI
NMG94637Medicare UPIN