Provider Demographics
NPI:1841294758
Name:STAMM, ROBERT BRAD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRAD
Last Name:STAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:502 ELM ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2512
Mailing Address - Country:US
Mailing Address - Phone:505-841-1000
Mailing Address - Fax:505-843-2956
Practice Address - Street 1:2085 S PACHECO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6103
Practice Address - Country:US
Practice Address - Phone:505-984-8012
Practice Address - Fax:505-984-1567
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM83-312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25064Medicaid
NM25064Medicaid