Provider Demographics
NPI:1043275779
Name:CUNDIFF, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:CUNDIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:115 HUSTON DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7250
Practice Address - Country:US
Practice Address - Phone:502-955-7311
Practice Address - Fax:502-955-9694
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000521654FOtherHUMANA - CMA
KY009120OtherSIHO - CMA
KY1193031OtherCHA - CMA
KY00000350678OtherANTHEM - CMA
KY2560159-001OtherCIGNA - CMA
KY1069658OtherPASSPORT - CMA
KY64179377Medicaid
KY2434792000OtherPASSPORT ADVANTAGE
KYP00181600OtherRAILROAD MEDICARE
KYC73713Medicare UPIN
KY1069658OtherPASSPORT - CMA