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NPI Code Detail

MEDICARE: DR. DANIEL A PUMMILL M.D.

MEDICARE: DR. DANIEL A PUMMILL 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
1207Q00000XFamily Medicine Physician12734OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
153055OTHERARBCBS AR

General Provider Information

NPI Number : 1851341218
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL A PUMMILL M.D.
Provider Business Mailing Address
First Line : PO BOX 80
Second Line :
City : KANSAS
State : OK
Zip : 74347-0080
Country : US
Telephone Number : 918-868-2175
Fax Number : 918-868-2944
Provider Business Practice Location Address
First Line : 1261 E TULSA AVE
Second Line :
City : KANSAS
State : OK
Zip : 74347-7026
Country : US
Telephone Number : 918-868-2175
Fax Number : 918-868-2944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/10/2007

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