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Organization

RUBEN A. SUPAN, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RUBEN SUPAN NP (NURSE PRACTITIONER)
(505) 409-0831
Entity
Organization

Contact information

Practice address
405 W COUNTRY CLUB RD, ROSWELL, NM 88201-5209
(575) 363-3134
(575) 208-0780
Mailing address
PO BOX 8244, ROSWELL, NM 88202-8244
(575) 208-0224

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
23386363
NM
Enumeration date
05/29/2018
Last updated
07/06/2021
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