Provider Demographics
NPI:1023170040
Name:CUMMINGS, ROBERT DALE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612-0160
Mailing Address - Country:US
Mailing Address - Phone:409-276-2067
Mailing Address - Fax:409-276-2059
Practice Address - Street 1:1017 FM 105
Practice Address - Street 2:
Practice Address - City:EVADALE
Practice Address - State:TX
Practice Address - Zip Code:77615-0130
Practice Address - Country:US
Practice Address - Phone:409-276-2067
Practice Address - Fax:409-276-2059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD48166Medicare UPIN