Provider Demographics
NPI:1568818243
Name:PHILIPOSE, JOBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOBIN
Middle Name:
Last Name:PHILIPOSE
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 1:4351 E LOHMAN AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8260
Mailing Address - Country:US
Mailing Address - Phone:575-522-0116
Mailing Address - Fax:575-522-0094
Practice Address - Street 1:4401 E LOHMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8267
Practice Address - Country:US
Practice Address - Phone:575-522-0116
Practice Address - Fax:575-522-0094
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2023-06-23
Deactivation Date:2017-01-10
Deactivation Code:
Reactivation Date:2017-03-30
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-1140207RG0100X, 207RG0100X
NY302030-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine