Provider Demographics
NPI:1245226455
Name:REIDY, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:REIDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:806 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3657
Practice Address - Country:US
Practice Address - Phone:505-842-6575
Practice Address - Fax:505-764-8796
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
NM75-234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM002263OtherBC BS OF NM
CO91-752345Medicaid
AZ252586Medicaid
NM180014471OtherRRB MEDICARE RAILROAD
NM19356Medicaid
AZ252586Medicaid
NM19356Medicaid