Provider Demographics
NPI:1952465197
Name:MAYFIELD, ROBERT C (PH D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:PH D
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 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:125 CHAPARREL BLVD NW
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-8629
Practice Address - Country:US
Practice Address - Phone:575-546-4800
Practice Address - Fax:575-546-0685
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0943103TC1900X, 103TC0700X
NMNM 0010C103TP0016X
NM0008103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33530084Medicaid
NM18677037Medicaid
NM10075381Medicaid
200521039OtherMEDICARE GROUP
200521039OtherMEDICARE GROUP
NM33530084Medicaid