Provider Demographics
NPI:1396839940
Name:CUMMINGS, DANIEL ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROSS
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 1:4300 GOLDEN CENTER DRIVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-344-2060
Mailing Address - Fax:530-622-2314
Practice Address - Street 1:4300 GOLDEN CENTER DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-344-2060
Practice Address - Fax:530-622-2314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43176207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G431760Medicaid
CA00G431760Medicaid
CA00G431760Medicare ID - Type Unspecified