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General NPI Number Information
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NPI Number | 1083024590
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Entity Type | Individual
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Provider Name | JACOB P MUMM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1332 TEASLEY LN STE 180
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City | DENTON
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State | TX
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Zip | 76205-7946
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Country | US
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Telephone | 940-220-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 3497 OZARK ACRES DR
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City | BENTONVILLE
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State | AR
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Zip | 72713-6367
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Country | US
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Telephone | 479-321-1516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 583388
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 583388
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E-13242
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License Number State | AR
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