Provider Demographics
NPI:1255395836
Name:ROBISON, JAMES WENDALL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WENDALL
Last Name:ROBISON
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 1:5601 PLANETA CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1416
Mailing Address - Country:US
Mailing Address - Phone:505-821-3292
Mailing Address - Fax:
Practice Address - Street 1:5601 PLANETA CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1416
Practice Address - Country:US
Practice Address - Phone:505-821-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80241207N00000X
NMNM80241207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850305120OtherTRIWEST
NM070001336OtherRAILROAD MEDICARE
NM207N00000XMedicaid
NM070001336OtherRAILROAD MEDICARE
D35914Medicare UPIN