Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 34264 | KY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 34264 | TN |
NPI | 1205812948 |
---|---|
Provider Name | Dr. Richard Burns Cunningham JR. |
First Address | Knoxville, TN 37930-2569 |
Second Address | Somerset, KY 42503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 04/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3851816 | (05) | TN |
G11383 | (02) |