Provider Demographics
NPI:1548258775
Name:BUBLIS, PAUL ANTON (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTON
Last Name:BUBLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 E KATY LN
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88242-5042
Mailing Address - Country:US
Mailing Address - Phone:575-318-8910
Mailing Address - Fax:
Practice Address - Street 1:1801 E KATY LN
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88242-5042
Practice Address - Country:US
Practice Address - Phone:806-665-0801
Practice Address - Fax:806-665-8503
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1145-00207Q00000X
TXK2655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA2422Medicaid
G77595Medicare UPIN