Provider Demographics
NPI:1942385448
Name:SAN JUAN OBSTETRICS & GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:SAN JUAN OBSTETRICS & GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:KARABIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-325-9191
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00H5795Medicaid
NM00H5795Medicaid