Healthcare Provider Details

I. General information

NPI: 1568818243
Provider Name (Legal Business Name): JOBIN PHILIPOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date: 01/10/2017
Reactivation Date: 03/30/2017

III. Provider practice location address

4401 E LOHMAN AVE STE C
LAS CRUCES NM
88011-8267
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 211
LAS CRUCES NM
88011-8260
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0116
  • Fax: 575-522-0094
Mailing address:
  • Phone: 575-522-0116
  • Fax: 575-522-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2021-1140
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number302030-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: