Provider Demographics
NPI:1326284936
Name:BUMPAS, RYAN LEE
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEE
Last Name:BUMPAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 DOROTHY LN S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1731
Mailing Address - Country:US
Mailing Address - Phone:817-763-8360
Mailing Address - Fax:
Practice Address - Street 1:3523 DOROTHY LN S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1731
Practice Address - Country:US
Practice Address - Phone:817-763-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor