Provider Demographics
NPI:1932282225
Name:GAZAROV, ALEKSANDR G (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:G
Last Name:GAZAROV
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 1:101 LIVINGSTON LOOP, BLDG C, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9753
Mailing Address - Country:US
Mailing Address - Phone:575-589-2025
Mailing Address - Fax:575-589-2605
Practice Address - Street 1:101 LIVINGSTON LOOP, BLDG C, SUITE 3
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9442
Practice Address - Country:US
Practice Address - Phone:575-589-2022
Practice Address - Fax:575-589-2605
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-07572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry