Provider Demographics
NPI:1871687699
Name:CUNNINGHAM, GARY KINCAID II (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KINCAID
Last Name:CUNNINGHAM
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S DENVER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-1075
Mailing Address - Country:US
Mailing Address - Phone:918-488-8888
Mailing Address - Fax:
Practice Address - Street 1:624 S DENVER AVE STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-1075
Practice Address - Country:US
Practice Address - Phone:918-488-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2745207R00000X, 208600000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84179Medicare UPIN