Provider Demographics
NPI:1033140512
Name:FUNCKES, CYNTHIA G (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:G
Last Name:FUNCKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 N. WYATT DR.
Mailing Address - Street 2:STE. 260
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-795-0549
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:5750 E. HIGHWAY 90
Practice Address - Street 2:STE. 300 A & B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-8075
Practice Address - Fax:520-458-0339
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25845207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ180692OtherMEDICARE
AZ25845OtherAZ MED. LICENSE
AZ399247Medicaid
AZZ180692OtherMEDICARE
AZ21135Medicare ID - Type Unspecified