Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 583388 | TX |
Y | 207P00000X | Emergency Physician | E-13242 | AR |
N | 207RA0401X | Internist - Addiction Medicine | 583388 | TX |
NPI | 1083024590 |
---|---|
Provider Name | Dr. Jacob P Mumm |
First Address | Lafayette, LA 70508-3870 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 16/08/2021 |