Healthcare Provider Details

I. General information

NPI: 1205812948
Provider Name (Legal Business Name): RICHARD BURNS CUNNINGHAM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 BOGLE ST
SOMERSET KY
42503
US

IV. Provider business mailing address

PO BOX 32569
KNOXVILLE TN
37930-2569
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-2220
  • Fax: 606-451-0595
Mailing address:
  • Phone: 865-694-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number34264
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number34264
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: