Provider Demographics
NPI:1245223569
Name:SCHWARTZ, ROBERT E (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:SCHWARTZ
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 1:405 W COUNTRY CLUB RD
Mailing Address - Street 2:C/O MSO ADMINSTRATION
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5209
Mailing Address - Country:US
Mailing Address - Phone:575-625-2669
Mailing Address - Fax:575-624-4599
Practice Address - Street 1:300 W COUNTRY CLUB RD
Practice Address - Street 2:SUITE # 130
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5202
Practice Address - Country:US
Practice Address - Phone:575-625-2669
Practice Address - Fax:575-624-4599
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15158R207X00000X
NMMD2006-0496207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001H95OtherBCBS OF NEW MEXICO
P00351009OtherRAILROAD MCARE
NM25338803Medicaid
NM349626901Medicare PIN
NMNM001H95OtherBCBS OF NEW MEXICO
LA5R240B103Medicare ID - Type Unspecified