Provider Demographics
NPI:1154420115
Name:BIEDERMANN, ROBERT E (DO)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:BIEDERMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:301
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-532-9755
Mailing Address - Fax:575-532-8881
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:301
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-532-9755
Practice Address - Fax:575-532-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0642208100000X
NMA-1787-13208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42378826Medicaid
G04781Medicare UPIN
NM42378826Medicaid