Provider Demographics
NPI:1750386470
Name:EWING, JOSEPH GRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GRAHAM
Last Name:EWING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA
Mailing Address - Street 2:BLDG. A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3417
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:8600 BATAAN MEMORIAL E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-6016
Practice Address - Country:US
Practice Address - Phone:575-373-9202
Practice Address - Fax:575-373-9592
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2003-0577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM341402409OtherMEDICARE
NM13406582Medicaid
NMA36092Medicare UPIN