MEDICARE: DR. MICHAEL THOMAS 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	207RC0000X	Cardiovascular Disease Physician	G36179	CA

General Provider Information

NPI Number	:	1982674305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMAS MUMFORD M.D.

Provider Business Mailing Address
First Line	:	3617 S TIMBER ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-4947
Country	:	US
Telephone Number	:	714-540-1924
Fax Number	:	714-540-1309

Provider Business Practice Location Address
First Line	:	2740 S BRISTOL ST
Second Line	:	SUITE 216
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6209
Country	:	US
Telephone Number	:	714-540-1924
Fax Number	:	714-540-6302

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/08/2014

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