Healthcare Provider Details

I. General information

NPI: 1902239635
Provider Name (Legal Business Name): ROBBEN R. GINGERY, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ALERO CIR NE
RIO RANCHO NM
87124-0807
US

IV. Provider business mailing address

105 ALERO CIR NE
RIO RANCHO NM
87124-0807
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8978
  • Fax: 505-702-8920
Mailing address:
  • Phone: 505-702-8978
  • Fax: 505-702-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number91-207
License Number StateNM

VIII. Authorized Official

Name: ROBBEN R. GINGERY
Title or Position: M.D.
Credential: MD
Phone: 505-702-8978