Healthcare Provider Details

I. General information

NPI: 1306934435
Provider Name (Legal Business Name): TIMOTHY P BUMANN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 ANTILLEY RD ABILENE REGIONAL WOUND CARE CENTER
ABILENE TX
79606-5742
US

IV. Provider business mailing address

730 EAST EUREKA STREET
WEATHERFORD TX
76086-6546
US

V. Phone/Fax

Practice location:
  • Phone: 325-428-2807
  • Fax: 325-428-2819
Mailing address:
  • Phone: 817-596-7000
  • Fax: 817-596-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberG7177
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: