Provider Demographics
NPI:1902239635
Name:ROBBEN R. GINGERY, MD
Entity Type:Organization
Organization Name:ROBBEN R. GINGERY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ROBBEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-702-8978
Mailing Address - Street 1:105 ALERO CIR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-0807
Mailing Address - Country:US
Mailing Address - Phone:505-702-8978
Mailing Address - Fax:505-702-8920
Practice Address - Street 1:105 ALERO CIR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-0807
Practice Address - Country:US
Practice Address - Phone:505-702-8978
Practice Address - Fax:505-702-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-2072084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME0179Medicaid
NME0179Medicaid
NMB530804Medicare UPIN