Healthcare Provider Details

I. General information

NPI: 1841237864
Provider Name (Legal Business Name): JOHN A CUNNINGHAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 PADDINGTON PL
ST AUGUSTINE FL
32092-3660
US

IV. Provider business mailing address

3829 PADDINGTON PL
ST AUGUSTINE FL
32092-3660
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-6049
  • Fax: 904-940-4811
Mailing address:
  • Phone: 904-940-6049
  • Fax: 904-940-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: