Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2325 | AZ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2325 | AZ |
NPI | 1104856475 |
---|---|
Provider Name | Douglas L Cunningham |
First Address | Phoenix, AZ 85015-4602 |
Second Address | Phoenix, AZ 85015-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 13/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C98198 | (02) |