Provider Demographics
NPI:1164453502
Name:BOXER, RICHARD B (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:BOXER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:PMG KASEMAN SLEEP LAB
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-291-2700
Practice Address - Fax:505-291-2989
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2003-0605207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5075351Medicaid
NM5075351Medicaid
H98644Medicare UPIN