MEDICARE: DAVID D GUMMIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	42056-020	WI
2	207P00000X	Emergency Medicine Physician	036094168	IL
3	207P00000X	Emergency Medicine Physician	MD2023-1333	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930091555	OTHER	WI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	399729456001	OTHER	WI	BCBS OF WISCONSIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497702898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID D GUMMIN M.D.

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 UNIVERSITY OF NEW MEXICO
Second Line	:	MSC 07 4390
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131
Country	:	US
Telephone Number	:	505-272-4261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	03/13/2025

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Directions to “ DAVID D GUMMIN M.D.” Practice Location

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