Healthcare Provider Details

I. General information

NPI: 1225145451
Provider Name (Legal Business Name): DAVID MUMFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9563 BORGATA BAY BLVD
LAS VEGAS NV
89147-8014
US

IV. Provider business mailing address

7121 W CRAIG RD #113 PMB 198
LAS VEGAS NV
89129-6001
US

V. Phone/Fax

Practice location:
  • Phone: 702-818-5933
  • Fax: 702-818-5934
Mailing address:
  • Phone: 702-395-0405
  • Fax: 702-395-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number7359
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: