Healthcare Provider Details

I. General information

NPI: 1255422101
Provider Name (Legal Business Name): ROBBEN RAINES GINGERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 SOUTHERN BLVD SE SUITE B1
RIO RANCHO NM
87124-1990
US

IV. Provider business mailing address

3188 SOUTHERN BLVD SE SUITE B1
RIO RANCHO NM
87124-1990
US

V. Phone/Fax

Practice location:
  • Phone: 505-200-9158
  • Fax: 505-200-9497
Mailing address:
  • Phone: 505-200-9158
  • Fax: 505-200-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number91-207
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number91-207
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: