Provider Demographics
NPI:1417904590
Name:GOSSUM, ROBIN SANN (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:SANN
Last Name:GOSSUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1631 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4728
Mailing Address - Country:US
Mailing Address - Phone:505-424-0200
Mailing Address - Fax:505-424-6608
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-424-0200
Practice Address - Fax:505-424-6608
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM99-215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00068358Medicaid
NMNM001H17OtherBCBS NM
1000473OtherLOVELACE
2340202OtherUHC
2083796OtherCCN
PROVP13125OtherMOLINA
202007381OtherPRESBYTERIAN HEALTH PLANS
9120159OtherPHCS
202007381OtherPRESBYTERIAN HEALTH PLANS
NMG95951Medicare UPIN