Basic Information
Provider Information
NPI: 1417273806
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GORDON
FirstName: ERIN
MiddleName: MURATA
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 26666
Address2: PROVIDER ENROLLMENT
City: ALBUQUERQUE
State: NM
PostalCode: 871256666
CountryCode: US
TelephoneNumber: 5059236770
FaxNumber:  
Practice Location
Address1: 1 UNIVERSITY OF NEW MEXICO
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871310001
CountryCode: US
TelephoneNumber: 5052726883
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2010
LastUpdateDate: 07/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMD2014-0260NMY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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