Healthcare Provider Details

I. General information

NPI: 1043270531
Provider Name (Legal Business Name): CHARLES DAVID PUMPHREY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29798 HAUN RD STE 304
SUN CITY CA
92586-6542
US

IV. Provider business mailing address

29798 HAUN RD STE 304
SUN CITY CA
92586-6542
US

V. Phone/Fax

Practice location:
  • Phone: 951-679-3159
  • Fax: 951-679-0250
Mailing address:
  • Phone: 951-679-3159
  • Fax: 951-679-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG59205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: