Provider Demographics
NPI:1366420747
Name:BIUNNO, EILEEN (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BIUNNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1000
Mailing Address - Fax:505-722-1192
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-722-1192
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-1402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00049373OtherRAILROAD MEDICARE
NM201000850OtherPRESBYTERIAN HEALTH/SALUD
85031326887301A099OtherCHAMPUS
NM10002097OtherLOVELACE HEALTH/SALUD
NMR6765Medicaid
AZ413328OtherAHCCCS
NMNM011561OtherBC/BS
R003830002Medicare ID - Type Unspecified
NM10002097OtherLOVELACE HEALTH/SALUD