Provider Demographics
NPI:1194837120
Name:CHAVEZ, GERZAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERZAIN
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4830
Mailing Address - Country:US
Mailing Address - Phone:505-471-8994
Mailing Address - Fax:505-473-1274
Practice Address - Street 1:4001 RODEO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4830
Practice Address - Country:US
Practice Address - Phone:505-471-8994
Practice Address - Fax:505-473-1274
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-28207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM029008OtherBCBS NM
2191728OtherUHC
NMQMYPRO0074100OtherMOLINA
202014955OtherPRESBYTERIAN HEALTH PLAN
NMT6682Medicaid
202014955OtherPRESBYTERIAN HEALTH PLAN
NMG76384Medicare UPIN