Provider Demographics
NPI:1477559425
Name:MILLER, ROBERT BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:MILLER
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:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1560
Mailing Address - Country:US
Mailing Address - Phone:505-563-2800
Mailing Address - Fax:505-563-2821
Practice Address - Street 1:4343 PAN AMERICAN FWY NE STE 236
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6834
Practice Address - Country:US
Practice Address - Phone:505-563-2800
Practice Address - Fax:505-563-2821
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-3392080P0203X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9873Medicaid
NMT9873Medicaid
NMG21285Medicare UPIN