Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00038353 | WA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD00038353 | WA |
NPI | 1497707715 |
---|---|
Provider Name | David R Cundiff |
First Address | Ilwaco, WA 98624-0170 |
Second Address | Long Beach, WA 98631-3806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 07/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F72944 | (02) |