=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285788042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD DEAN MUMA PA-C, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1845 FAIRMOUNT ST WICHITA STATE UNIVERSITY
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67260-0043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-978-3060
-----------------------------------------------------
Fax | 316-978-3072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1845 FAIRMOUNT ST WICHITA STATE UNIVERSITY
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67260-0043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-978-3060
-----------------------------------------------------
Fax | 316-978-3072
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 15-00430
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------