Provider Demographics
NPI:1770879694
Name:UNM MEDICAL GROUP INC
Entity type:Organization
Organization Name:UNM MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ASSISTANT PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, JD
Authorized Official - Phone:505-272-1161
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3203
Mailing Address - Fax:
Practice Address - Street 1:1801 CAMINO DE SALUD NE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4516
Practice Address - Country:US
Practice Address - Phone:505-925-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental