Provider Demographics
NPI:1780080382
Name:DALLAS, RUEBEN JR (RN)
Entity type:Individual
Prefix:
First Name:RUEBEN
Middle Name:
Last Name:DALLAS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 S ZENO ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3248
Mailing Address - Country:US
Mailing Address - Phone:720-530-7596
Mailing Address - Fax:
Practice Address - Street 1:700 DELAWARE ST
Practice Address - Street 2:UROLOGY DEPT., DAVIS PAVILION, 2ND FLOOR, SOUTH TOWER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4532
Practice Address - Country:US
Practice Address - Phone:303-602-6087
Practice Address - Fax:303-602-6283
Is Sole Proprietor?:No
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0193782163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse