Healthcare Provider Details

I. General information

NPI: 1922065333
Provider Name (Legal Business Name): PAUL MCCONNELL BUMPERS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S 54TH ST
ROGERS AR
72758-8169
US

IV. Provider business mailing address

2100 S 54TH ST
ROGERS AR
72758-8169
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-7077
  • Fax: 479-271-7035
Mailing address:
  • Phone: 479-271-7077
  • Fax: 479-271-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC6578
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: