Healthcare Provider Details

I. General information

NPI: 1497815187
Provider Name (Legal Business Name): JOYCE LOUISE BUMGARDNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E DEWEY AVE
SAPULPA OK
74066-4201
US

IV. Provider business mailing address

7919 S JOPLIN AVE
TULSA OK
74136-9120
US

V. Phone/Fax

Practice location:
  • Phone: 918-227-2016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13094
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: