Healthcare Provider Details

I. General information

NPI: 1194741595
Provider Name (Legal Business Name): JASON L UMPHRESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COTTONWOOD ST SUITE 203
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

1321 COTTONWOOD ST SUITE 203
WOODLAND CA
95695-5131
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-1631
  • Fax:
Mailing address:
  • Phone: 530-666-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA64129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: