Individual
MARK S MUMFORD
Active
Individual
MARK S MUMFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
13413
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050011293
MCRR
TN
01
—
100010583
PHP TENNCARE
TN
05
—
3188681
—
TN
01
—
50019
BLUECROSS
TN
Enumeration date
01/06/2006
Last updated
06/16/2010
Update your record
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