Individual
MR. BLAIR KENT HOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1010 SPRUCE ST, PMG ESPANOLA, ESPANOLA, NM 87532-2724
(505) 367-0362
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301056501
MI
208600000X
Surgery Physician
Primary
MD2016-0486
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101364
SHN HOSPITAL GLHP
MI
05
—
4250727
—
MI
05
—
4258841
—
MI
Enumeration date
05/23/2006
Last updated
07/28/2016
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