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NPI Code Detail

MEDICARE: ROBERT M UNDERWOOD M.D.

MEDICARE: ROBERT M UNDERWOOD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD2018-0896NM
2207Q00000XFamily Medicine Physician0101230784VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2930116680OTHERVARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881636785
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT M UNDERWOOD M.D.
Provider Business Mailing Address
First Line : PO BOX 6210
Second Line :
City : FARMINGTON
State : NM
Zip : 87499-6210
Country : US
Telephone Number : 505-609-2258
Fax Number : 505-609-2259
Provider Business Practice Location Address
First Line : 4820 E MAIN ST
Second Line :
City : FARMINGTON
State : NM
Zip : 87402-8660
Country : US
Telephone Number : 505-609-6495
Fax Number : 505-324-0504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 05/29/2019

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