Individual
BRETT T MUMFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
301 CEDAR ST, OROFINO, ID 83544-9029
(208) 476-5777
(208) 476-5385
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 476-5777
(208) 476-5385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
O-266
ID
207Q00000X
Family Medicine Physician
O266
ID
Other
Enumeration date
06/09/2006
Last updated
09/01/2020
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