Healthcare Provider Details

I. General information

NPI: 1316053002
Provider Name (Legal Business Name): ROBERT L MILNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR SE SUITE 306 PMG GENERAL SURGERY CEDAR
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-1000
  • Fax: 505-563-1010
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number81-270
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: