Provider Demographics
NPI:1861544918
Name:PEREA, JOSEPH RUBEN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RUBEN
Last Name:PEREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4300 SAN MATEO BLVD NE
Mailing Address - Street 2:SUITE B270
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1229
Mailing Address - Country:US
Mailing Address - Phone:505-883-7525
Mailing Address - Fax:505-883-7535
Practice Address - Street 1:4300 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE B270
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1229
Practice Address - Country:US
Practice Address - Phone:505-883-7525
Practice Address - Fax:505-883-7535
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM 80-79207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00022848Medicaid
NM00NM007852OtherBCBS OF NEW MEXICO
NM00022848Medicaid
NMD35881Medicare UPIN