Healthcare Provider Details

I. General information

NPI: 1851911622
Provider Name (Legal Business Name): DANIELLE MUMFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR
HAMMOND LA
70403-1426
US

IV. Provider business mailing address

PO BOX 2668
HOUSTON TX
77252-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2663
  • Fax: 985-230-2665
Mailing address:
  • Phone: 985-230-2663
  • Fax: 985-230-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number354422
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: