1245223569 NPI number — DR. ROBERT E SCHWARTZ MD

Table of content: DR. ROBERT E SCHWARTZ MD (NPI 1245223569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245223569 NPI number — DR. ROBERT E SCHWARTZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
ROBERT
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245223569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 W COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
C/O MSO ADMINSTRATION
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88201-5209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-625-2669
Provider Business Mailing Address Fax Number:
575-624-4599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
SUITE # 130
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-5202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-625-2669
Provider Business Practice Location Address Fax Number:
575-624-4599
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  15158R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: MD2006-0496 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM001H95 . This is a "BCBS OF NEW MEXICO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: P00351009 . This is a "RAILROAD MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25338803 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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