Provider Demographics
NPI:1942413885
Name:GWENN S ROBINSON MD PC
Entity Type:Organization
Organization Name:GWENN S ROBINSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-821-2985
Mailing Address - Street 1:6100 PAN AMERICAN EAST FWY NE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3427
Mailing Address - Country:US
Mailing Address - Phone:505-821-2985
Mailing Address - Fax:
Practice Address - Street 1:6100 PAN AMERICAN EAST FWY NE
Practice Address - Street 2:SUITE 430
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3427
Practice Address - Country:US
Practice Address - Phone:505-821-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 76-253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22772Medicaid
NM22772Medicaid
D35912Medicare UPIN