Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | S2430 | TX |
NPI | 1326427790 |
---|---|
Provider Name | Marysa D. Mumphrey |
First Address | San Antonio, TX 78229-4402 |
Second Address | San Antonio, TX 78229-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
412831601 | (05) | TX |
412831602 | CSHCN (01) | TX |