Provider Demographics
NPI:1104815802
Name:DCUNHA, NICHOLAS CYRIL (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CYRIL
Last Name:DCUNHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-3150
Mailing Address - Fax:806-743-3168
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-8600
Practice Address - Fax:806-775-8602
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7702207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82190Medicaid
TX200002960AMedicaid
TX87226ZOtherHMO BLUE
NM82190OtherPRESYBTERIAN COMMERCIAL
A558OtherTRIWEST
TX132035100Medicaid
TX132035101OtherFIRSTCARE COMMERCIAL
TX156575602Medicaid
TX8H3320OtherBC/BS
TX156575601Medicaid
NM40873251Medicaid
TX132035101OtherFIRSTCARE COMMERCIAL
TXF12741Medicare UPIN
TX830008706Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX156575601Medicaid