Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 402 | TX |
NPI | 1073924767 |
---|---|
Provider Name | Donald Cummings |
First Address | Dallas, TX 75219-3924 |
Second Address | Dallas, TX 75219-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
402 | TEXAS BOARD OF ORTHOTISTS AND PROSTHETISTS (01) | TX |