Provider Demographics
NPI:1295778710
Name:CARUANA, LEE C (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:C
Last Name:CARUANA
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 1:411 SOUTH 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-4041
Mailing Address - Country:US
Mailing Address - Phone:575-445-3626
Mailing Address - Fax:575-445-8649
Practice Address - Street 1:411 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4005
Practice Address - Country:US
Practice Address - Phone:575-445-3626
Practice Address - Fax:575-445-8649
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000025684Medicaid
NM000025684Medicaid