Individual
DR. CLEORA SHUNKAMOLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
89-303
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419475
—
AZ
05
—
R7335
—
NM
Enumeration date
03/09/2006
Last updated
12/29/2016
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