Provider Demographics
NPI:1699950741
Name:GERARDO J. MOREIRA, M.D., P.A.
Entity type:Organization
Organization Name:GERARDO J. MOREIRA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-577-0111
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 1:5060 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:505-589-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM348328901Medicaid
TX1151755-02Medicaid
TX1151755-02Medicaid
NM800521091Medicare PIN