Provider Demographics
NPI:1477842250
Name:CUMMINGS, JEFFREY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
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 1:11211N NEBRASKA AVE A5
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5767
Mailing Address - Country:US
Mailing Address - Phone:813-514-2333
Mailing Address - Fax:305-851-4110
Practice Address - Street 1:12901 BRUCE B. DOWNS BLVD, MDC 41
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5209
Practice Address - Country:US
Practice Address - Phone:813-844-7412
Practice Address - Fax:813-844-7995
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME-119304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program