Provider Demographics
NPI:1477711653
Name:MCCUMBER, MARY ANN (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MCCUMBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E SOUTH TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1507
Mailing Address - Country:US
Mailing Address - Phone:801-350-4631
Mailing Address - Fax:
Practice Address - Street 1:1050 E SOUTH TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1507
Practice Address - Country:US
Practice Address - Phone:801-350-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012356207P00000X
MDH0072507207P00000X
UT5082124-1204207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine