Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | D28090 | MD |
NPI | 1316276140 |
---|---|
Provider Name | Dr. John Christian Umhau |
First Address | Whiteriver, AZ 85941-0860 |
Second Address | Whiteriver, AZ 85941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2009 |
Last Update Date | 07/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020561 | (05) | AZ |
846790 | (05) | AZ |
E7650 | (02) | |
HSZ962RBU | WHITERIVER (01) | |
HSZ962RBV | (02) |