Provider Demographics
NPI:1255422101
Name:GINGERY, ROBBEN RAINES (MD)
Entity type:Individual
Prefix:
First Name:ROBBEN
Middle Name:RAINES
Last Name:GINGERY
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 1:3188 SOUTHERN BLVD SE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1990
Mailing Address - Country:US
Mailing Address - Phone:505-200-9158
Mailing Address - Fax:505-200-9497
Practice Address - Street 1:3188 SOUTHERN BLVD SE
Practice Address - Street 2:SUITE B1
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1990
Practice Address - Country:US
Practice Address - Phone:505-200-9158
Practice Address - Fax:505-200-9497
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-2072084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME0179Medicaid