Provider Demographics
NPI:1225090046
Name:HOBBS, JAN DELOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:DELOS
Last Name:HOBBS
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 1:601 W COUNTRY CLUB RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5225
Mailing Address - Country:US
Mailing Address - Phone:575-622-2911
Mailing Address - Fax:575-622-2598
Practice Address - Street 1:601 W COUNTRY CLUB RD STE 202
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-622-2911
Practice Address - Fax:575-622-2598
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0390207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28033833Medicaid
NMNM009D18OtherBCBS
NM90859561Medicaid
NM28033833Medicaid
NM90859561Medicaid