Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD2007-0031 | NM |
N | 208000000X | Pediatrician | MD2007-0031 | NM |
NPI | 1346432846 |
---|---|
Provider Name | Tom Cushing |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 22/03/2017 |