Provider Demographics
NPI:1831205095
Name:CUMMINGS, ROBERT CHARLES (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PA-C
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 517
Mailing Address - Street 2:
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0517
Mailing Address - Country:US
Mailing Address - Phone:307-283-2476
Mailing Address - Fax:307-283-2255
Practice Address - Street 1:713 OAK STREET
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729-0517
Practice Address - Country:US
Practice Address - Phone:307-283-2476
Practice Address - Fax:307-283-2489
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY113363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYR04539Medicare UPIN