Healthcare Provider Details

I. General information

NPI: 1548258775
Provider Name (Legal Business Name): PAUL ANTON BUBLIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E KATY LN
HOBBS NM
88242-5042
US

IV. Provider business mailing address

1801 E KATY LN
HOBBS NM
88242-5042
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-0801
  • Fax: 806-665-8503
Mailing address:
  • Phone: 575-318-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-1145-00
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK2655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: