Provider Demographics
NPI:1346256997
Name:LAST, REUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:
Last Name:LAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:REUBEN
Other - Middle Name:
Other - Last Name:LAST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1501 SAN PEDRO DR SE
Mailing Address - Street 2:3B-112
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-5153
Mailing Address - Country:US
Mailing Address - Phone:505-265-1711
Mailing Address - Fax:505-256-5743
Practice Address - Street 1:2ND AMBULATORY CARE CTR
Practice Address - Street 2:2211 LOMAS BLVD. NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346256997OtherMEDICARE (THE OTHER NUMBER)
NMG62298Medicare UPIN