Provider Demographics
NPI:1841237864
Name:CUNNINGHAM, JOHN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 PADDINGTON PL
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3660
Mailing Address - Country:US
Mailing Address - Phone:904-940-6049
Mailing Address - Fax:904-940-4811
Practice Address - Street 1:3829 PADDINGTON PL
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3660
Practice Address - Country:US
Practice Address - Phone:904-940-6049
Practice Address - Fax:904-940-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3192213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340529000Medicaid
FLP00260023OtherRAILROAD MEDICARE
FLP00260023OtherRAILROAD MEDICARE
4159690001Medicare NSC
FLT51483Medicare UPIN