Healthcare Provider Details

I. General information

NPI: 1316276140
Provider Name (Legal Business Name): JOHN CHRISTIAN UMHAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST HOSPITAL DR
WHITERIVER AZ
85941
US

IV. Provider business mailing address

200 WEST HOSPITAL DRIVE
WHITERIVER AZ
85941-0860
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-3555
  • Fax: 928-338-5508
Mailing address:
  • Phone: 928-338-3555
  • Fax: 928-338-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD28090
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: