Healthcare Provider Details

I. General information

NPI: 1629698865
Provider Name (Legal Business Name): UMER MUHAMMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date: 01/10/2022
Reactivation Date: 02/24/2022

III. Provider practice location address

202 E 50TH ST
JOPLIN MO
64804-4920
US

IV. Provider business mailing address

202 E 50TH ST
JOPLIN MO
64804-4920
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-3416
  • Fax: 417-556-3417
Mailing address:
  • Phone: 417-556-3416
  • Fax: 417-556-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023026711
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: