Provider Demographics
NPI:1780953869
Name:DOUGLAS L. MCPHERSON M.D.
Entity type:Organization
Organization Name:DOUGLAS L. MCPHERSON M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-551-5111
Mailing Address - Street 1:1211 8TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5808
Mailing Address - Country:US
Mailing Address - Phone:575-551-5111
Mailing Address - Fax:575-551-5112
Practice Address - Street 1:1211 8TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5808
Practice Address - Country:US
Practice Address - Phone:575-551-5111
Practice Address - Fax:575-551-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90249261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ8125Medicaid
NME12234Medicare UPIN
NM339732501Medicare PIN