Healthcare Provider Details

I. General information

NPI: 1033167093
Provider Name (Legal Business Name): ROBERT MARK RUMMEL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 WILLOW CREEK RD SUITE 200
PRESCOTT AZ
86301-1607
US

IV. Provider business mailing address

1022 WILLOW CREEK RD SUITE 200
PRESCOTT AZ
86301-1607
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-1341
  • Fax: 928-778-3993
Mailing address:
  • Phone: 928-445-1341
  • Fax: 928-778-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: