Basic Information
| Provider Information | |||||||||
| NPI: | 1427108083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUHRE | ||||||||
| FirstName: | E | ||||||||
| MiddleName: | DOW | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 SAINT MICHAELS DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058205227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 465 SAINT MICHAELS DR | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059842600 | ||||||||
| FaxNumber: | 5059837299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 47652 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 7496 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 47652 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 7496 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 16004 | 01 | MOLINA | OTHER | 7496 | 01 | NM | NEW MEXICO LICENSE | OTHER | AS6230964 | 01 | DEA | OTHER | NM002A16 | 01 | NM | BCBS NM | OTHER | 01131 | 05 | NM | MEDICAID |