Healthcare Provider Details

I. General information

NPI: 1639094097
Provider Name (Legal Business Name): GARY H ROBINS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3363
US

IV. Provider business mailing address

PO BOX 20017
COLORADO CITY CO
81019-2017
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-3145
  • Fax:
Mailing address:
  • Phone: 719-671-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: