Individual
DR. FRED KELLY CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5300 BEE CAVE ROAD BLDG I, STE 260, AUSTIN, TX 78746-5226
(512) 410-0767
(512) 649-7402
Mailing address
5300 BEE CAVES RD STE 260, WEST LAKE HILLS, TX 78746-5226
(512) 410-0767
(512) 649-7402
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
G4944
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1278600001
MEDICARE SUPPLIER NUMBER
TX
05
—
131598805
—
TX
Enumeration date
01/24/2006
Last updated
02/14/2023
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