Basic Information
| Provider Information | |||||||||
| NPI: | 1114940822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYASE | ||||||||
| FirstName: | GERHARD | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | M..D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 GIBSON BLVD SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871084729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627960 | ||||||||
| FaxNumber: | 5052321368 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 CARLISLE BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871074503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058888500 | ||||||||
| FaxNumber: | 5058888503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD2007-0117 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.