MEDICARE: ROBIN SANN GOSSUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	99-215	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NM001H17	OTHER	NM	BCBS NM
3	1000473	OTHER		LOVELACE
4	2340202	OTHER		UHC
5	2083796	OTHER		CCN
6	PROVP13125	OTHER		MOLINA
7	202007381	OTHER		PRESBYTERIAN HEALTH PLANS
8	9120159	OTHER		PHCS

General Provider Information

NPI Number	:	1417904590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN SANN GOSSUM MD

Provider Business Mailing Address
First Line	:	1631 HOSPITAL DR
Second Line	:	SUITE 200
City	:	SANTA FE
State	:	NM
Zip	:	87505-4728
Country	:	US
Telephone Number	:	505-424-0200
Fax Number	:	505-424-6608

Provider Business Practice Location Address
First Line	:	1631 HOSPITAL DR
Second Line	:	SUITE 200
City	:	SANTA FE
State	:	NM
Zip	:	87505-4728
Country	:	US
Telephone Number	:	505-424-0200
Fax Number	:	505-424-6608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/01/2011

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Directions to “ ROBIN SANN GOSSUM MD” Practice Location

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