Provider Demographics
NPI:1487658126
Name:RUBIN, JEFFREY N (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:N
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 LOUISIANA BLVD NE
Mailing Address - Street 2:STE 401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7020
Mailing Address - Country:US
Mailing Address - Phone:505-260-4300
Mailing Address - Fax:505-260-4338
Practice Address - Street 1:1205 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4748
Practice Address - Country:US
Practice Address - Phone:505-260-4300
Practice Address - Fax:505-260-4338
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-938-91207L00000X
TXQ1287207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME3909Medicaid
NMNM014A51OtherBLUE CROSS BLUE SHIELD
NMNM014A51OtherBLUE CROSS BLUE SHIELD