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General NPI Number Information
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NPI Number | 1972689859
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Entity Type | Organization
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Legal Business Name | MICHAEL T MUMFORD MD INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 2740 S BRISTOL ST 218
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City | SANTA ANA
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State | CA
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Zip | 92704-6209
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Country | US
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Telephone | 714-540-1924
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Fax | 714-540-6302
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Provider Business Mailing Address
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Address Line | 2740 S BRISTOL ST 218
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City | SANTA ANA
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State | CA
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Zip | 92704-6209
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Country | US
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Telephone | 714-540-1924
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Fax | 714-540-6302
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MICHAEL THOMAS MUMFORD
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Credential | M D
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Telephone | 714-540-1924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G36179
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License Number State | CA
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