Provider Demographics
NPI:1821078254
Name:RUMMEL, DAVID MARK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:RUMMEL
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 1:6842 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2517
Mailing Address - Country:US
Mailing Address - Phone:480-221-7802
Mailing Address - Fax:
Practice Address - Street 1:6842 HAWTHORNE DRIVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2517
Practice Address - Country:US
Practice Address - Phone:480-221-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10776A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY144258900Medicaid
AZ503319Medicaid
050068243OtherMEDICARE RAILROAD
050068243OtherMEDICARE RAILROAD