Individual
TINA J SOUTHWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
75 UNIVERISTY BLVD, STE 130, ROSWELL, NM 88203
(575) 624-7207
Mailing address
PO BOX 1574, ROSWELL, NM 88202-1574
(575) 624-3470
(575) 627-9520
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
95-PA10
NM
Other
Enumeration date
08/13/2006
Last updated
07/12/2019
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