Healthcare Provider Details

I. General information

NPI: 1104815802
Provider Name (Legal Business Name): NICHOLAS CYRIL DCUNHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

PO BOX 5865
LUBBOCK TX
79408-5865
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-8600
  • Fax: 806-775-8602
Mailing address:
  • Phone: 806-743-3150
  • Fax: 806-743-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberL7702
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL7702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: