Provider Demographics
NPI:1013078781
Name:ROYBAL, ANITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:M
Last Name:ROYBAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1101 GOLF COURSE RD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4731
Mailing Address - Country:US
Mailing Address - Phone:505-234-1612
Mailing Address - Fax:505-234-1618
Practice Address - Street 1:1101 GOLF COURSE RD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4731
Practice Address - Country:US
Practice Address - Phone:505-234-1612
Practice Address - Fax:505-234-1618
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-10-02
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Provider Licenses
StateLicense IDTaxonomies
NM84-1102083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ6735Medicaid
NM400343OtherPTAN INDIVIDUAL
B26040Medicare UPIN