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Individual

JOHN PAUL BUMGARDNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1145 HIGHWAY 42, PETAL, MS 39465-9740
(601) 544-0500
(601) 544-0505
Mailing address
322 BAKER ST, PETAL, MS 39465-3806
(601) 467-3442
(256) 350-7757

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT3992
MS

Other

Enumeration date
09/21/2006
Last updated
07/08/2007
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