Provider Demographics
NPI:1538193818
Name:EDWARD, ROBIN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:MARIE
Last Name:EDWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 7TH ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2590 CAMINO ENTRADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4876
Practice Address - Country:US
Practice Address - Phone:505-820-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-235208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001V06OtherBCBS NM
NM24458Medicaid
10003823OtherLOVELACE
000810805781OtherPHCS
1955062OtherUHC
202010595OtherPRESBYTERIAN HEALTH PLANS
PROVP13122OtherMOLINA
1955062OtherUHC
202010595OtherPRESBYTERIAN HEALTH PLANS