Individual
JABEZ BABU JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 SARA RD SE, RIO RANCHO, NM 87124-1025
(505) 253-7900
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0146391
NM
207Q00000X
Family Medicine Physician
1629349576
AZ
207Q00000X
Family Medicine Physician
Primary
MD2021-0456
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629349576
NPI
—
Enumeration date
01/24/2012
Last updated
08/20/2021
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