Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3724 | AL |
Y | 1223D0001X | Dental Public Health | 3724 | AL |
NPI | 1225111396 |
---|---|
Provider Name | Dr. Robert A Cummings |
First Address | Mobile, AL 36603-5827 |
Second Address | Mount Vernon, AL 36560-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011846 | MAIN GROUP MEDICARE PAYEE NUMBER (01) | AL |
1063439065 | MAIN GROUP NPI PAYEE NUMBER (01) | AL |
3724 | STATE LIC (01) | AL |
630000013 | (05) | AL |