MEDICARE: DR. PAUL MCCONNELL BUMPERS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	C6578	AR

General Provider Information

NPI Number	:	1922065333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MCCONNELL BUMPERS JR. MD

Provider Business Mailing Address
First Line	:	2100 S 54TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8169
Country	:	US
Telephone Number	:	479-271-7077
Fax Number	:	479-271-7035

Provider Business Practice Location Address
First Line	:	2100 S 54TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8169
Country	:	US
Telephone Number	:	479-271-7077
Fax Number	:	479-271-7035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	12/30/2014

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