Provider Demographics
NPI:1245248814
Name:GRIEGO, RUBEN RAUL (MD)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:RAUL
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RUBEN
Other - Middle Name:RAUL
Other - Last Name:GRIEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10489
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87184-0489
Mailing Address - Country:US
Mailing Address - Phone:505-262-7026
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:5150 JOURNAL CENTER BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-262-3233
Practice Address - Fax:505-262-3191
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39891Medicaid
NM39891Medicaid