Individual
DR. PAUL F ENGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
342 SHERRILL LN, ROSWELL, NM 88201-5819
(575) 625-0123
(575) 625-0131
Mailing address
342 SHERRILL LN, ROSWELL, NM 88201-5819
(575) 625-0123
(575) 625-0131
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2000-181
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12313
CIDC
NM
01
—
76-0161899
FED TAX ID
NM
05
—
B3625
—
NM
01
—
NM009129
BCBS
NM
01
—
P00344526
RAILROAD MEDICARE PIN
NM
Enumeration date
03/09/2006
Last updated
04/04/2024
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