Healthcare Provider Details

I. General information

NPI: 1639134422
Provider Name (Legal Business Name): JOHN PATRICK CUELLAR III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S SOUTH ST
MOUNT AIRY NC
27030-4422
US

IV. Provider business mailing address

PO BOX 1267
MOUNT AIRY NC
27030-1267
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-4522
  • Fax: 336-789-3025
Mailing address:
  • Phone: 336-719-7112
  • Fax: 336-786-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37813
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: