Provider Demographics
NPI:1326047952
Name:CUNNINGHAM, LAURENCE WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:WILLIAM
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PEBBLE BEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766
Mailing Address - Country:US
Mailing Address - Phone:432-686-6605
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:406 PEBBLE BEACH DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766
Practice Address - Country:US
Practice Address - Phone:432-221-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8685207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364290ZV0WOtherTX MEDICARE
TX00N64QOtherBCBS
TX8U8522OtherBLUE CROSS
TXG8685OtherSTATE LICENSE
TXP00422917OtherRAILROAD MEDICARE
TX133706506Medicaid
TX00N64QMedicare PIN
TX8U8522OtherBLUE CROSS
TXP00422917Medicare PIN
TX8L1583Medicare PIN