Healthcare Provider Details

I. General information

NPI: 1386784460
Provider Name (Legal Business Name): BARBARA A. BUMBERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 S FREMONT AVE
SPRINGFIELD MO
65804-7328
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-5015
  • Fax: 417-820-5026
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: