MEDICARE: ROGER R CUMMINS PA-C

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	363A00000X	Physician Assistant	PA00512	OR

General Provider Information

NPI Number	:	1871581520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER R CUMMINS PA-C

Provider Business Mailing Address
First Line	:	13750 SPRINGLAKE RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-8806
Country	:	US
Telephone Number	:	541-891-6462
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-883-5130
Fax Number	:

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/14/2025

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