Provider Demographics
NPI:1003890468
Name:STUMP, BONNIE S (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:STUMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7728
Mailing Address - Country:US
Mailing Address - Phone:512-863-0790
Mailing Address - Fax:512-863-8620
Practice Address - Street 1:2120 SCENIC DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7728
Practice Address - Country:US
Practice Address - Phone:512-863-0790
Practice Address - Fax:512-863-8620
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4575207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B26756Medicare UPIN
TX00410DMedicare ID - Type Unspecified