Provider Demographics
NPI:1235203134
Name:STEVEN C ROBESON MD PC
Entity Type:Organization
Organization Name:STEVEN C ROBESON MD PC
Other - Org Name:STEVEN C. ROBESON, MD AND ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-982-3534
Mailing Address - Street 1:1630 HOSPITAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4772
Mailing Address - Country:US
Mailing Address - Phone:505-982-3534
Mailing Address - Fax:505-982-8458
Practice Address - Street 1:1630 HOSPITAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4772
Practice Address - Country:US
Practice Address - Phone:505-982-3534
Practice Address - Fax:505-982-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78-247208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06501575Medicaid
NM17210Medicaid
NM09755276Medicaid
NMH61490Medicare UPIN
NM06501575Medicaid