Provider Demographics
NPI:1356338008
Name:WILSON-RAMIREZ, GINA B (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:B
Last Name:WILSON-RAMIREZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4661
Practice Address - Country:US
Practice Address - Phone:907-261-3111
Practice Address - Fax:907-565-8066
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2024-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK5130207P00000X
NM2000-316207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5717Medicaid
H36217Medicare UPIN
AKMD5717Medicaid