Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 20122 | MS |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 43312 | TN |
NPI | 1073798781 |
---|---|
Provider Name | Jeff Jordan Cunningham |
First Address | Southaven, MS 38672-9618 |
Second Address | Southaven, MS 38672-9618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 09/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09123759 | (05) | MS |
321032B | (02) | MS |