Provider Demographics
NPI:1992929087
Name:MUMMA, SAMUEL METZGER
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:METZGER
Last Name:MUMMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PRAN
Other - Middle Name:M
Other - Last Name:MUMMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:9744 US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-1850
Mailing Address - Country:US
Mailing Address - Phone:352-523-2876
Mailing Address - Fax:352-523-2830
Practice Address - Street 1:9744 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-1850
Practice Address - Country:US
Practice Address - Phone:352-523-2876
Practice Address - Fax:352-523-2830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 540171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist