Provider Demographics
NPI:1114054673
Name:CUNNINGHAM, KEVIN RAY (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAY
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-1429
Mailing Address - Country:US
Mailing Address - Phone:254-629-1744
Mailing Address - Fax:254-629-3904
Practice Address - Street 1:400 W PLUMMER ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2627
Practice Address - Country:US
Practice Address - Phone:254-629-1744
Practice Address - Fax:254-629-3904
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine