Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DD2136 | NM |
N | 1223G0001X | General Practice | 30-01-9397 | OH |
N | 213EG0000X | General Practice | 30-01-9397 | OH |
N | 1223G0001X | General Practice | DD2136 | NM |
N | 213EG0000X | General Practice | DD2136 | NM |
NPI | 1720085749 |
---|---|
Provider Name | Gary William Cuttrell |
First Address | Albuquerque, NM 87123-4485 |
Second Address | Albuquerque, NM 87102-4516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 29/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19569 | (02) | NM |