Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 26468 | KY |
Y | 208600000X | Surgeon | 26468 | KY |
N | 2082S0105X | Plastic Hand Surgeon | 26468 | KY |
NPI | 1235146028 |
---|---|
Provider Name | Thomas D Cummins |
First Address | Louisville, KY 40207-1102 |
Second Address | Louisville, KY 40207-1298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 12/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000051549 | ANTHEM BCBS (01) | |
1052955 | PASSPORT HEALTH (GROUP) (01) | KY |
1052957 | PASSPORT HEALTH (INDIVID) (01) | KY |
64264682 | (05) | KY |
E07411 | (02) | KY |