Healthcare Provider Details

I. General information

NPI: 1245248814
Provider Name (Legal Business Name): RUBEN RAUL GRIEGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RUBEN RAUL GRIEGO

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

PO BOX 10489
ALBUQUERQUE NM
87184-0489
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-3233
  • Fax: 505-262-3191
Mailing address:
  • Phone: 505-262-7026
  • Fax: 505-727-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: