1063621993 NPI number — GEHRON P TREME MD

Table of content: GEHRON P TREME MD (NPI 1063621993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063621993 NPI number — GEHRON P TREME MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREME
Provider First Name:
GEHRON
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063621993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 UNIVERSITY OF NEW MEXICO # 105600
Provider Second Line Business Mailing Address:
UNM HEALTH SCIENCES CENTER
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87131-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-4107
Provider Business Mailing Address Fax Number:
505-272-8098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 LOMAS BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-2745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-4107
Provider Business Practice Location Address Fax Number:
505-272-8098
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD2009-0074 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4K785D847 . This is a "MEDICARE LEGACY NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033081 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS00214348 . This is a "CONTROLLED SUBSTANCE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 201666 . This is a "STATE LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: CI9478 . This is a "RAILROAD MEDICARE GROUP LEGACY NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: MD2009-0074 . This is a "STATE LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: P00464726 . This is a "RAILROAD MEDICARE INDIVIDUAL LEGACY NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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