Provider Demographics
NPI:1467444091
Name:MARKWELL, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MARKWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
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 1:1204 US HIGHWAY 60 WEST
Practice Address - Street 2:SOCORRO GENERAL MEDICAL GROUP
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801
Practice Address - Country:US
Practice Address - Phone:575-838-4690
Practice Address - Fax:575-838-4689
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM81-83207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17434Medicaid
D35809Medicare UPIN
34M712414Medicare PIN