MEDICARE: DAVID R CUNDIFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00038353	WA
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	MD00038353	WA
3	2083P0901X	Public Health & General Preventive Medicine Physician	MD00038353	WA
4	207QA0401X	Addiction Medicine (Family Medicine) Physician	MD00038353	WA

General Provider Information

NPI Number	:	1497707715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R CUNDIFF M.D.

Provider Business Mailing Address
First Line	:	PO BOX E
Second Line	:
City	:	ILWACO
State	:	WA
Zip	:	98624-0170
Country	:	US
Telephone Number	:	360-867-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 WASHINGTON AVE N
Second Line	:
City	:	LONG BEACH
State	:	WA
Zip	:	98631-3806
Country	:	US
Telephone Number	:	360-244-4707
Fax Number	:	360-642-3014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/07/2021

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