Provider Demographics
NPI:1184649139
Name:ALANIZ, JERRY GILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:GILBERT
Last Name:ALANIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10174 HOPE HWY
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9522
Mailing Address - Country:US
Mailing Address - Phone:505-746-6349
Mailing Address - Fax:505-746-9840
Practice Address - Street 1:1105 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1189
Practice Address - Country:US
Practice Address - Phone:505-746-9848
Practice Address - Fax:505-746-9840
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78-101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32722Medicaid
NMC96819Medicare UPIN