Provider Demographics
NPI:1962591669
Name:CUMBY, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CUMBY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:240 CASA BLANCA RD
Mailing Address - Street 2:PO BOX 490
Mailing Address - City:CASA BLANCA
Mailing Address - State:NM
Mailing Address - Zip Code:87007-1071
Mailing Address - Country:US
Mailing Address - Phone:505-552-6034
Mailing Address - Fax:505-552-7645
Practice Address - Street 1:129 MEDICINE HORSE DR.
Practice Address - Street 2:PO BOX 3338
Practice Address - City:TOHAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87026-3338
Practice Address - Country:US
Practice Address - Phone:505-908-2307
Practice Address - Fax:505-908-2310
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM89-22207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10008446Medicare ID - Type Unspecified
G23098Medicare UPIN