Provider Demographics
NPI:1093717563
Name:KARABIN, JERRY MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MYRON
Last Name:KARABIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5631
Mailing Address - Country:US
Mailing Address - Phone:505-325-9191
Mailing Address - Fax:505-325-8585
Practice Address - Street 1:814 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5631
Practice Address - Country:US
Practice Address - Phone:505-325-9191
Practice Address - Fax:505-325-8585
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0540207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF84027Medicare UPIN
MS160000469Medicare ID - Type Unspecified