Provider Demographics
NPI:1568698066
Name:CUNNINGHAM, SCOTT ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ELLIS
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEBAUER GASTROENTEROLOGY
Practice Address - Street 2:520 N ELAM AVE
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1127
Practice Address - Country:US
Practice Address - Phone:336-547-1745
Practice Address - Fax:336-547-1824
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2022-05-27
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Provider Licenses
StateLicense IDTaxonomies
NC2019-02937207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherUPIN