Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5887 | AK |
N | 207QS0010X | Family Doctor - Sports Medicine | 5887 | AK |
NPI | 1013083286 |
---|---|
Provider Name | Shane W Cummings |
First Address | Anchorage, AK 99515-2031 |
Second Address | Anchorage, AK 99515-2031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 16/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012003 | (05) | AK |