Provider Demographics
NPI:1538114889
Name:CUMMINGS, DANIEL CLYDE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CLYDE
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 765
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84603-0765
Mailing Address - Country:US
Mailing Address - Phone:801-406-1044
Mailing Address - Fax:801-753-9044
Practice Address - Street 1:694 N 1890 W UNIT 44A
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1327
Practice Address - Country:US
Practice Address - Phone:801-406-1044
Practice Address - Fax:801-753-9044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT162225-1205207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122035700Medicaid
WY05875001OtherBLUE CROSS/BLUE SHIELD
A11650Medicare UPIN
WY05875001OtherBLUE CROSS/BLUE SHIELD