MEDICARE: DR. STUART BUMGARNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME161051	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912524471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART BUMGARNER MD

Provider Business Mailing Address
First Line	:	1414 KUHL AVE # MP31
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2008
Country	:	US
Telephone Number	:	407-841-5133
Fax Number	:	407-237-6313

Provider Business Practice Location Address
First Line	:	8011 OSCEOLA POLK LINE RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-9102
Country	:	US
Telephone Number	:	407-407-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	12/12/2024

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