Healthcare Provider Details

I. General information

NPI: 1891061123
Provider Name (Legal Business Name): ABEL BUMGARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 EL CAMINO REAL STE 250
BURLINGAME CA
94010-3111
US

IV. Provider business mailing address

360 POST ST STE 404
SAN FRANCISCO CA
94108-4907
US

V. Phone/Fax

Practice location:
  • Phone: 844-867-8444
  • Fax:
Mailing address:
  • Phone: 415-671-6819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA149258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: