Provider Demographics
NPI:1285636308
Name:CUMMINGS, BROCK (MD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:
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 1:6283 CLARK RD
Mailing Address - Street 2:STE 15
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-876-0410
Mailing Address - Fax:530-876-0423
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:STE 15
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-876-0410
Practice Address - Fax:530-876-0423
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A702050Medicaid
P00052511OtherMEDICARE RAILROAD #
P00052511OtherMEDICARE RAILROAD #
CA00A702050Medicaid