Basic Information
| Provider Information | |||||||||
| NPI: | 1962591669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMBY | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 CASA BLANCA RD | ||||||||
| Address2: | PO BOX 490 | ||||||||
| City: | CASA BLANCA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870071071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055526034 | ||||||||
| FaxNumber: | 5055527645 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 MEDICINE HORSE DR. | ||||||||
| Address2: | PO BOX 3338 | ||||||||
| City: | TOHAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870263338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082307 | ||||||||
| FaxNumber: | 5059082310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 06/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 89-22 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.