Provider Demographics
NPI:1912141011
Name:CUM, GEORGE STEVEN (IDMT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:STEVEN
Last Name:CUM
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GRIER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3704
Mailing Address - Country:US
Mailing Address - Phone:702-382-9051
Mailing Address - Fax:
Practice Address - Street 1:811 GRIER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3704
Practice Address - Country:US
Practice Address - Phone:702-382-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians