Healthcare Provider Details

I. General information

NPI: 1063446219
Provider Name (Legal Business Name): ROBERT G. CUTCHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 MASTHEAD ST. NE SUITE 100 SUITE A
ALBUQUERQUE NM
87109-4412
US

IV. Provider business mailing address

6121 THUNDERBIRD CIR NW
ALBUQUERQUE NM
87120-2163
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-8346
  • Fax: 505-848-8345
Mailing address:
  • Phone: 505-848-8346
  • Fax: 505-848-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPS2005-0798
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: