Provider Demographics
NPI:1376700757
Name:MUMME, DANIEL ELROY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ELROY
Last Name:MUMME
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 1:314 MARTIN LUTHER KING JR WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4271
Mailing Address - Country:US
Mailing Address - Phone:253-403-7257
Mailing Address - Fax:
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY STE 202
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4271
Practice Address - Country:US
Practice Address - Phone:253-403-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49735-20208600000X
WAMD60281878208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery