Provider Demographics
NPI:1952645129
Name:CUNNINGHAM, TROY
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 BRIARHILL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-9077
Mailing Address - Country:US
Mailing Address - Phone:409-886-0794
Mailing Address - Fax:409-886-0794
Practice Address - Street 1:4213 BRIARHILL AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-9077
Practice Address - Country:US
Practice Address - Phone:409-886-0794
Practice Address - Fax:409-886-0794
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor