Provider Demographics
NPI:1770530867
Name:ARIZAGA, GILBERT S (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:S
Last Name:ARIZAGA
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 1:3060 HIGHWAY 180 E
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7703
Mailing Address - Country:US
Mailing Address - Phone:575-388-2743
Mailing Address - Fax:575-388-8885
Practice Address - Street 1:3060 HIGHWAY 180 E
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7703
Practice Address - Country:US
Practice Address - Phone:575-388-2743
Practice Address - Fax:575-388-8885
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77124207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78377021Medicaid
NMC96826Medicare UPIN
NMNMA100003Medicare PIN
NM78377021Medicaid