Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0847 | TX |
NPI | 1336100791 |
---|---|
Provider Name | Dr. Jimmie D. Lummus |
First Address | San Angelo, TX 76901-1716 |
Second Address | San Angelo, TX 76901-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 10/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018722102 | (05) | TX |
8F1500 | BCBS (01) | TX |
A002 | TRICARE (01) | TX |
T14512 | (02) | TX |