Healthcare Provider Details

I. General information

NPI: 1285636308
Provider Name (Legal Business Name): BROCK CUMMINGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6283 CLARK RD STE 15
PARADISE CA
95969-4100
US

IV. Provider business mailing address

6283 CLARK RD STE 15
PARADISE CA
95969-4100
US

V. Phone/Fax

Practice location:
  • Phone: 530-876-0410
  • Fax: 530-876-0423
Mailing address:
  • Phone: 530-876-0410
  • Fax: 530-876-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA70205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: