Provider Demographics
NPI:1679694285
Name:GARY K. CUNNINGHAM, D.O.,P.C.
Entity Type:Organization
Organization Name:GARY K. CUNNINGHAM, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:KINCAID
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:918-488-8888
Mailing Address - Street 1:6901 S YORKTOWN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3986
Mailing Address - Country:US
Mailing Address - Phone:918-488-8888
Mailing Address - Fax:918-488-9512
Practice Address - Street 1:6901 S YORKTOWN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3986
Practice Address - Country:US
Practice Address - Phone:918-488-8888
Practice Address - Fax:918-488-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2745208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK447687655-00OtherBCBS
OKA002OtherTRICARE HUMANA
OKE84179Medicare UPIN