Healthcare Provider Details

I. General information

NPI: 1487658126
Provider Name (Legal Business Name): JEFFREY N RUBIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S TELSHOR BLVD
LAS CRUCES NM
88011-4748
US

IV. Provider business mailing address

1720 LOUISIANA BLVD NE STE 401
ALBUQUERQUE NM
87110-7020
US

V. Phone/Fax

Practice location:
  • Phone: 505-260-4300
  • Fax: 505-260-4338
Mailing address:
  • Phone: 505-260-4300
  • Fax: 505-260-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA-938-91
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ1287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: