Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 51884 | MN |
Y | 207X00000X | Orthopaedic Surgeon | 53249-20 | WI |
NPI | 1003911603 |
---|---|
Provider Name | Dr. Justin Shawn Cummins |
First Address | Ashland, WI 54806 |
Second Address | Ashland, WI 54806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 29/08/2018 |