MEDICARE: DAVID MUMFORD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	7359	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV1360	OTHER	NV	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7359	OTHER	NV	NV STATE BOARD MEDICAL

General Provider Information

NPI Number	:	1225145451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MUMFORD M.D.

Provider Business Mailing Address
First Line	:	7121 W CRAIG RD
Second Line	:	#113 PMB 198
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6001
Country	:	US
Telephone Number	:	702-395-0405
Fax Number	:	702-395-0401

Provider Business Practice Location Address
First Line	:	9563 BORGATA BAY BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8014
Country	:	US
Telephone Number	:	702-818-5933
Fax Number	:	702-818-5934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/09/2007

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Directions to “ DAVID MUMFORD M.D.” Practice Location

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