Healthcare Provider Details

I. General information

NPI: 1215908793
Provider Name (Legal Business Name): GEORGE SCOTT CUMING IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PLAZA DR STE 170
ROSEVILLE CA
95661-2867
US

IV. Provider business mailing address

12685 OLD WICK RD
SAN ANTONIO TX
78230-1947
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5555
  • Fax: 916-737-5555
Mailing address:
  • Phone: 210-846-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC200208
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTX78240
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16595A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE4281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: