Provider Demographics
NPI:1497926323
Name:CUNDIFF, JASON DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:CUNDIFF
Suffix:
Gender:M
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:PO BOX 631341
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 COMMONWEALTH DR STE 210
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4850
Practice Address - Country:US
Practice Address - Phone:864-675-4815
Practice Address - Fax:877-893-3779
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025774208600000X
SC88865208600000X
FLME134536208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023066800Medicaid