Provider Demographics
NPI:1609845320
Name:AISENBREY, GARY ANDREW (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ANDREW
Last Name:AISENBREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR SE #405
Mailing Address - Street 2:
Mailing Address - City:ALB
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-764-9535
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR SE #405
Practice Address - Street 2:
Practice Address - City:ALB
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-764-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-132207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02352Medicaid
NM345512302Medicare ID - Type Unspecified
NM02352Medicaid