Provider Demographics
NPI:1073618328
Name:ROBINSON, GWENN SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:GWENN
Middle Name:SUSAN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 PAN AMERICAN FREEWAY NE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-821-2985
Mailing Address - Fax:
Practice Address - Street 1:6100 PAN AMERICAN FREEWAY NE
Practice Address - Street 2:SUITE 430
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-821-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM76253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127299Medicare ID - Type Unspecified
D35912Medicare UPIN