Healthcare Provider Details

I. General information

NPI: 1689617532
Provider Name (Legal Business Name): DAVID GUMM PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N 27TH ST SUITE 201
BILLINGS MT
59101-0101
US

IV. Provider business mailing address

1101 N 27TH ST SUITE 201
BILLINGS MT
59101-0101
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-3585
  • Fax: 406-237-3586
Mailing address:
  • Phone: 406-237-3585
  • Fax: 406-237-3586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number245
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: