MEDICARE: MICHAEL T MUMFORD MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G36179	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972689859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL T MUMFORD MD INC

Provider Business Mailing Address
First Line	:	2740 S BRISTOL ST
Second Line	:	218
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6209
Country	:	US
Telephone Number	:	714-540-1924
Fax Number	:	714-540-6302

Provider Business Practice Location Address
First Line	:	2740 S BRISTOL ST
Second Line	:	218
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6209
Country	:	US
Telephone Number	:	714-540-1924
Fax Number	:	714-540-6302

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHAEL THOMAS MUMFORD
Credential	:	M D
Telephone Number	:	714-540-1924

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	01/09/2009

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