Provider Demographics
NPI:1992896583
Name:CUNDY, RICHARD L (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:CUNDY
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 1:2800 S UNIVERSITY BLVD UNIT 95
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6057
Mailing Address - Country:US
Mailing Address - Phone:303-753-0890
Mailing Address - Fax:
Practice Address - Street 1:2005 FRANKLIN ST
Practice Address - Street 2:MIDTOWN 1, STE. 430
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5401
Practice Address - Country:US
Practice Address - Phone:303-832-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01154665Medicaid
CO01154665Medicaid
COD22856Medicare ID - Type Unspecified