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General NPI Number Information
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NPI Number | 1114940822
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Entity Type | Individual
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Provider Name | GERHARD Y NYASE M..D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 9101 MONTGOMERY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2405
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Country | US
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Telephone | 505-275-4288
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Fax | 505-275-4203
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Provider Business Mailing Address
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Address Line | PO BOX 26028
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2007-0117
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License Number State | NM
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