Individual
DR. JACK H BUMGARDNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
195 MAPLE AVE, ROCKY MOUNT, VA 24151-1506
(540) 483-5168
(540) 483-5835
Mailing address
195 MAPLE AVE, ROCKY MOUNT, VA 24151-1506
(540) 483-5168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101-021970
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005623669
—
VA
Enumeration date
01/23/2006
Last updated
03/28/2014
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