=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316112220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS G. CUMMINS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2008
-----------------------------------------------------
Last Update Date | 02/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2512 XENIA ST SUITE 105
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79072-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-296-9300
-----------------------------------------------------
Fax | 806-296-9301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2512 XENIA ST SUITE 105
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79072-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-296-9300
-----------------------------------------------------
Fax | 806-296-9301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DOUGLAS G CUMMINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 806-296-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------