Healthcare Provider Details

I. General information

NPI: 1760787287
Provider Name (Legal Business Name): DERRICK UMPHLETT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 W CAMPBELL AVE
PHOENIX AZ
85031-1703
US

IV. Provider business mailing address

8970 E RAINTREE DR SUITE 100
SCOTTSDALE AZ
85260-7300
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-9300
  • Fax: 480-609-9350
Mailing address:
  • Phone: 480-609-9300
  • Fax: 480-609-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DERRICK C. UMPHLETT
Title or Position: OWNER
Credential: MD
Phone: 480-609-9300