Healthcare Provider Details

I. General information

NPI: 1235203134
Provider Name (Legal Business Name): STEVEN C ROBESON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 HOSPITAL DR SUITE C
SANTA FE NM
87505-4772
US

IV. Provider business mailing address

1630 HOSPITAL DR SUITE C
SANTA FE NM
87505-4772
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-3534
  • Fax: 505-982-8458
Mailing address:
  • Phone: 505-982-3534
  • Fax: 505-982-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number78-247
License Number StateNM

VIII. Authorized Official

Name: DR. STEVEN C ROBESON
Title or Position: PRESIDENT
Credential: MD
Phone: 505-982-3534