Healthcare Provider Details

I. General information

NPI: 1083024590
Provider Name (Legal Business Name): JACOB P MUMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 TEASLEY LN STE 180
DENTON TX
76205-7946
US

IV. Provider business mailing address

3497 OZARK ACRES DR
BENTONVILLE AR
72713-6367
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-8899
  • Fax:
Mailing address:
  • Phone: 479-321-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number583388
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number583388
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-13242
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: