Healthcare Provider Details

I. General information

NPI: 1538114889
Provider Name (Legal Business Name): DANIEL CLYDE CUMMINGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 N 1890 W UNIT 44A
PROVO UT
84601-1327
US

IV. Provider business mailing address

PO BOX 765
PROVO UT
84603-0765
US

V. Phone/Fax

Practice location:
  • Phone: 801-406-1044
  • Fax: 801-753-9044
Mailing address:
  • Phone: 801-406-1044
  • Fax: 801-753-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number162225-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: