Provider Demographics
NPI:1699735100
Name:HEMPHILL, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HEMPHILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 CORRALES RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8663
Mailing Address - Country:US
Mailing Address - Phone:505-400-5544
Mailing Address - Fax:833-974-2306
Practice Address - Street 1:4313 CORRALES RD STE 2
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8663
Practice Address - Country:US
Practice Address - Phone:505-400-5544
Practice Address - Fax:833-974-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20040714207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55285261Medicaid
NMT56450Medicare UPIN