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General NPI Number Information
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NPI Number | 1497815187
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Entity Type | Individual
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Provider Name | JOYCE LOUISE BUMGARDNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 E DEWEY AVE
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City | SAPULPA
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State | OK
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Zip | 74066-4201
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Country | US
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Telephone | 918-227-2016
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Fax |
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Provider Business Mailing Address
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Address Line | 7919 S JOPLIN AVE
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City | TULSA
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State | OK
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Zip | 74136-9120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13094
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License Number State | OK
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