Provider Demographics
NPI:1972689859
Name:MICHAEL T MUMFORD MD INC
Entity Type:Organization
Organization Name:MICHAEL T MUMFORD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:714-540-1924
Mailing Address - Street 1:2740 S BRISTOL ST
Mailing Address - Street 2:218
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6209
Mailing Address - Country:US
Mailing Address - Phone:714-540-1924
Mailing Address - Fax:714-540-6302
Practice Address - Street 1:2740 S BRISTOL ST
Practice Address - Street 2:218
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6209
Practice Address - Country:US
Practice Address - Phone:714-540-1924
Practice Address - Fax:714-540-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36179207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G3617900Medicaid
CAG36179Medicare ID - Type Unspecified
CAA91754Medicare UPIN
CA1972689859Medicare PIN