Healthcare Provider Details

I. General information

NPI: 1508855719
Provider Name (Legal Business Name): DONALD G CUNNINGHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15425 N GREENWAY HAYDEN LOOP STE A300
SCOTTSDALE AZ
85260-1204
US

IV. Provider business mailing address

15425 N GREENWAY HAYDEN LOOP STE A300
SCOTTSDALE AZ
85260-1204
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-1124
  • Fax: 480-607-1087
Mailing address:
  • Phone: 480-607-1124
  • Fax: 480-607-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0732
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: