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NPI Code Detail

MEDICARE: DR. CAROLE EVA GERVAIS M.D.

MEDICARE:  DR. CAROLE EVA GERVAIS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD2017-0881NM

General Provider Information

NPI Number : 1366443954
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLE EVA GERVAIS M.D.
Provider Business Mailing Address
First Line : 5904 HOLLY AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-2472
Country : US
Telephone Number : 505-298-2505
Fax Number : 505-298-2985
Provider Business Practice Location Address
First Line : 5904 HOLLY AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-2472
Country : US
Telephone Number : 212-247-8100
Fax Number : 212-247-8093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 04/07/2021

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Directions to “ DR. CAROLE EVA GERVAIS M.D.” Practice Location

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