Healthcare Provider Details

I. General information

NPI: 1912524471
Provider Name (Legal Business Name): STUART BUMGARNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 OSCEOLA POLK LINE RD
DAVENPORT FL
33896-9102
US

IV. Provider business mailing address

1414 KUHL AVE # MP31
ORLANDO FL
32806-2008
US

V. Phone/Fax

Practice location:
  • Phone: 407-407-0200
  • Fax:
Mailing address:
  • Phone: 407-841-5133
  • Fax: 407-237-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME161051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: