Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 27267 | AZ |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 27267 | AZ |
NPI | 1629035944 |
---|---|
Provider Name | Dr. Devin Matthew Cunning |
First Address | Lake Havasu City, AZ 86403-6559 |
Second Address | Lake Havasu City, AZ 86403-6559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 12/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
469868 | (05) | AZ |
G92497 | (02) | AZ |