Provider Demographics
NPI:1497702898
Name:GUMMIN, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:GUMMIN
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 1:1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:MSC 07 4390
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:505-272-4261
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC 07 4390
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42056-020207P00000X
IL036094168207P00000X
NMMD2023-1333207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094168Medicaid
WI930091555OtherMEDICARE RAILROAD
WI1497702898Medicaid
WI399729456001OtherBCBS OF WISCONSIN
WI0008-10006Medicare ID - Type Unspecified
WI1497702898Medicaid
WI0078-01400Medicare ID - Type Unspecified
WI399729456001OtherBCBS OF WISCONSIN
WI0077-68655Medicare ID - Type Unspecified
WI68086 1231Medicare PIN
G83681Medicare UPIN
WI0042-32280Medicare ID - Type Unspecified
WI0010-45034Medicare ID - Type Unspecified