Individual
DR. JOHN R. BUMBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1965 S FREMONT AVE, SUITE 100, SPRINGFIELD, MO 65804-2201
(417) 820-3800
(417) 820-3810
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
102513
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010019524
RAILROAD MEDICARE
MO
05
—
203696513
—
MO
01
—
431560263
TRICARE
—
Enumeration date
11/29/2006
Last updated
05/02/2013
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