Basic Information
| Provider Information | |||||||||
| NPI: | 1104815802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DCUNHA | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | CYRIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067433150 | ||||||||
| FaxNumber: | 8067433168 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067758600 | ||||||||
| FaxNumber: | 8067758602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | L7702 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | L7702 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 82190 | 05 | NM | MEDICAID | 200002960A | 05 | TX | MEDICAID | 87226Z | 01 | TX | HMO BLUE | OTHER | 82190 | 01 | NM | PRESYBTERIAN COMMERCIAL | OTHER | A558 | 01 | TRIWEST | OTHER | 132035100 | 05 | TX | MEDICAID | 132035101 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 156575602 | 05 | TX | MEDICAID | 8H3320 | 01 | TX | BC/BS | OTHER | 156575601 | 05 | TX | MEDICAID | 40873251 | 05 | NM | MEDICAID |