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NPI Code Detail

MEDICARE: DERRICK CLIFTON UMPHLETT MD

MEDICARE: DERRICK CLIFTON UMPHLETT MD
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
1207L00000XAnesthesiology Physician35861AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417968538
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK CLIFTON UMPHLETT MD
Provider Business Mailing Address
First Line : 645 E MISSOURI AVE
Second Line : STE 300
City : PHOENIX
State : AZ
Zip : 85012-1351
Country : US
Telephone Number : 602-262-8917
Fax Number : 602-262-8890
Provider Business Practice Location Address
First Line : 2400 S AVENUE A
Second Line :
City : YUMA
State : AZ
Zip : 85364-7170
Country : US
Telephone Number : 928-344-2000
Fax Number : 928-336-7430
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 12/30/2020

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