Provider Demographics
NPI:1063499150
Name:CUMMINS, JOE C (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:C
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2425 DAVE WARD DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8686
Mailing Address - Country:US
Mailing Address - Phone:501-329-3824
Mailing Address - Fax:501-327-2957
Practice Address - Street 1:2425 DAVE WARD DR
Practice Address - Street 2:SUITE 401
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8686
Practice Address - Country:US
Practice Address - Phone:501-329-3824
Practice Address - Fax:501-327-2957
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC6816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111613001Medicaid
AR043853Medicare Oscar/Certification
C14946Medicare UPIN
AR111613001Medicaid