Healthcare Provider Details

I. General information

NPI: 1730683129
Provider Name (Legal Business Name): JARED M BUMP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CONNER CIR
SANTA ROSA BEACH FL
32459-5027
US

IV. Provider business mailing address

96 CONNER CIR
SANTA ROSA BEACH FL
32459-5027
US

V. Phone/Fax

Practice location:
  • Phone: 561-713-4166
  • Fax:
Mailing address:
  • Phone: 561-713-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS17380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: