Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 5192 | SC |
NPI | 1215996822 |
---|---|
Provider Name | Mr. Calhoun D Cunningham |
First Address | Myrtle Beach, SC 29572-4621 |
Second Address | Myrtle Beach, SC 29572-4621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 30/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051927 | (05) | SC |
D17767 | (02) |