Provider Demographics
NPI:1003811795
Name:CUMMINGS, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1833
Mailing Address - Country:US
Mailing Address - Phone:503-538-4544
Mailing Address - Fax:503-538-9257
Practice Address - Street 1:506 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1833
Practice Address - Country:US
Practice Address - Phone:503-538-4544
Practice Address - Fax:503-538-9257
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233684Medicaid
OR233684Medicaid
ORR0000BHPRMMedicare ID - Type Unspecified