Provider Demographics
NPI:1063415701
Name:BIAZAK, GARY J (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:BIAZAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1720 LOUISIANA BLVD NE
Mailing Address - Street 2:STE 401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7020
Mailing Address - Country:US
Mailing Address - Phone:505-260-4300
Mailing Address - Fax:505-260-4338
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-260-4300
Practice Address - Fax:505-260-4338
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-25
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM77-133207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11565Medicaid
AZ250910Medicaid
CO91771337Medicaid
NM21113Medicaid
NMNM009C58OtherBLUE CROSS BLUE SHEILD
NMNM009C58OtherBLUE CROSS BLUE SHEILD