Provider Demographics
NPI:1700040227
Name:DUKEMINIER, GERALD (DOM,)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:DUKEMINIER
Suffix:
Gender:M
Credentials:DOM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28415 US 285
Mailing Address - Street 2:
Mailing Address - City:LAMY
Mailing Address - State:NM
Mailing Address - Zip Code:87540-9510
Mailing Address - Country:US
Mailing Address - Phone:505-466-8876
Mailing Address - Fax:
Practice Address - Street 1:500 DON GASPAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2626
Practice Address - Country:US
Practice Address - Phone:505-988-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM099RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist