Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC28360 | CA |
NPI | 1407973696 |
---|---|
Provider Name | Dr. Theodore J Cummins |
First Address | Oakdale, CA 95361-3957 |
Second Address | Oakdale, CA 95361-3957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |