Provider Demographics
NPI:1437258951
Name:MURAIDA, GERARD EDWARD (MD, CMD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:EDWARD
Last Name:MURAIDA
Suffix:
Gender:M
Credentials:MD, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9512 SEABROOK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5886
Mailing Address - Country:US
Mailing Address - Phone:505-821-5404
Mailing Address - Fax:505-821-3148
Practice Address - Street 1:5639 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3412
Practice Address - Country:US
Practice Address - Phone:505-821-5404
Practice Address - Fax:505-821-3148
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-96207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42-173Medicaid
NM42-173Medicaid