Provider Demographics
NPI:1831164094
Name:SWEETSER, EDWARD R (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:SWEETSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4351 E. LOHMAN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-532-9755
Mailing Address - Fax:575-532-8881
Practice Address - Street 1:4351 E. LOHMAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-532-9755
Practice Address - Fax:575-532-8881
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM77-108207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71084746Medicaid
NM15156Medicaid
NMD35993Medicare UPIN
NM71084746Medicaid