Provider Demographics
NPI:1972557551
Name:DE LAS ALAS, REUBEN (MD)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:
Last Name:DE LAS ALAS
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:PO BOX 636019
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:142 S MAIN ST
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2922
Practice Address - Country:US
Practice Address - Phone:434-799-2222
Practice Address - Fax:434-799-3857
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034517207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
252-110-2OtherECFMG
VAP00342780OtherRAILROAD MEDICARE
VA005886139Medicaid
NC7905041Medicaid
VA010313848Medicaid
VAP00342780OtherRRGA
VAP00342780OtherRRGA
NC7905041Medicaid
B59886Medicare UPIN
00V332D82Medicare ID - Type UnspecifiedGRP C08682
VA013529E59Medicare PIN
VA00X105E05Medicare PIN