Healthcare Provider Details

I. General information

NPI: 1508846528
Provider Name (Legal Business Name): JEFFREY M. BUMPOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST SUITE 710
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

401 E CHESTNUT ST SUITE 710
LOUISVILLE KY
40202-5700
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-8303
  • Fax: 502-584-0302
Mailing address:
  • Phone: 502-583-8303
  • Fax: 502-584-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number30850
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: