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General NPI Number Information
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NPI Number | 1326427790
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Entity Type | Individual
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Provider Name | MARYSA D. MUMPHREY D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 4085 DE ZAVALA RD STE 150
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2084
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Country | US
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Telephone | 469-789-6767
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Fax | 210-368-6617
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Provider Business Mailing Address
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Address Line | 4085 DE ZAVALA RD STE 150
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2084
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Country | US
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Telephone | 210-368-6614
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Fax | 210-368-6617
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | S2430
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | S2430
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License Number State | TX
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