Healthcare Provider Details

I. General information

NPI: 1962591669
Provider Name (Legal Business Name): ELIZABETH CUMBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MEDICINE HORSE DR. PO BOX 3338
TOHAJIILEE NM
87026-3338
US

IV. Provider business mailing address

240 CASA BLANCA RD PO BOX 490
CASA BLANCA NM
87007-1071
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-2307
  • Fax: 505-908-2310
Mailing address:
  • Phone: 505-552-6034
  • Fax: 505-552-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89-22
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: