Provider Demographics
NPI:1861493991
Name:DELAHOUSSAYE, BRIAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:DELAHOUSSAYE
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 1420
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1420
Mailing Address - Country:US
Mailing Address - Phone:505-532-6054
Mailing Address - Fax:505-532-0215
Practice Address - Street 1:3530 FOOTHILLS RD
Practice Address - Street 2:STE. N
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3626
Practice Address - Country:US
Practice Address - Phone:505-532-6054
Practice Address - Fax:505-532-0215
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91547Medicare UPIN