Provider Demographics
NPI:1013935675
Name:MOREIRA, GERARDO J (MD, PA)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:J
Last Name:MOREIRA
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3616
Mailing Address - Country:US
Mailing Address - Phone:915-577-0111
Mailing Address - Fax:915-533-2568
Practice Address - Street 1:5065 MCNUTT RD
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:915-542-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ13202084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1151755-02Medicaid
NMF28006Medicaid
TX00J96BMedicare PIN
NMF28006Medicaid
TX1151755-02Medicaid
NM348328901Medicare ID - Type UnspecifiedMEDICARE NO.