Provider Demographics
NPI:1275602617
Name:ROBESON, STEVEN CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CRAIG
Last Name:ROBESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
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
NM17210Medicaid
NM17210Medicaid