Provider Demographics
NPI:1033527015
Name:ROBBEN R. GINGERY, MD, LLC
Entity Type:Organization
Organization Name:ROBBEN R. GINGERY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD LLC
Authorized Official - Phone:505-200-9158
Mailing Address - Street 1:3188 SOUTHERN BLVD SE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1990
Mailing Address - Country:US
Mailing Address - Phone:505-200-9158
Mailing Address - Fax:505-200-9497
Practice Address - Street 1:3188 SOUTHERN BLVD SE
Practice Address - Street 2:SUITE B1
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1990
Practice Address - Country:US
Practice Address - Phone:505-200-9158
Practice Address - Fax:505-200-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-2072084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty