Healthcare Provider Details

I. General information

NPI: 1427000942
Provider Name (Legal Business Name): ROBERT N EVERS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 CANDELARIA RD NE
ALBUQUERQUE NM
87110-3757
US

IV. Provider business mailing address

9032 SUNNY BROOK ST NE
ALBUQUERQUE NM
87113-2111
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-1511
  • Fax: 505-291-6878
Mailing address:
  • Phone: 505-823-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number017
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: