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General NPI Number Information
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NPI Number | 1851341218
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Entity Type | Individual
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Provider Name | DANIEL A PUMMILL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1261 E TULSA AVE
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City | KANSAS
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State | OK
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Zip | 74347-7026
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Country | US
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Telephone | 918-868-2175
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Fax | 918-868-2944
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Provider Business Mailing Address
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Address Line | PO BOX 80
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City | KANSAS
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State | OK
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Zip | 74347-0080
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Country | US
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Telephone | 918-868-2175
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Fax | 918-868-2944
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12734
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License Number State | OK
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