Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD07684 | OR |
NPI | 1003811795 |
---|---|
Provider Name | Dr. John L Cummings |
First Address | Newberg, OR 97132-1833 |
Second Address | Newberg, OR 97132-1833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 22/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
233684 | (05) | OR |
A23774 | (02) | OR |