Healthcare Provider Details

I. General information

NPI: 1346256997
Provider Name (Legal Business Name): REUBEN LAST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: REUBEN LAST M.D.

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2ND AMBULATORY CARE CTR 2211 LOMAS BLVD. NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1501 SAN PEDRO DR SE 3B-112
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2336
  • Fax:
Mailing address:
  • Phone: 505-265-1711
  • Fax: 505-256-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number97-299
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: