Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 162225-1205 | UT |
NPI | 1538114889 |
---|---|
Provider Name | Dr. Daniel Clyde Cummings |
First Address | Provo, UT 84603-0765 |
Second Address | Provo, UT 84601-1327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 06/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A11650 | (02) |