Provider Demographics
NPI:1851341218
Name:PUMMILL, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:PUMMILL
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 80
Mailing Address - Street 2:
Mailing Address - City:KANSAS
Mailing Address - State:OK
Mailing Address - Zip Code:74347-0080
Mailing Address - Country:US
Mailing Address - Phone:918-868-2175
Mailing Address - Fax:918-868-2944
Practice Address - Street 1:1261 E TULSA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:OK
Practice Address - Zip Code:74347-7026
Practice Address - Country:US
Practice Address - Phone:918-868-2175
Practice Address - Fax:918-868-2944
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53055OtherBCBS AR
C95379Medicare UPIN
AR53055Medicare ID - Type UnspecifiedRR MEDICARE AR
AR53055OtherBCBS AR