Provider Demographics
NPI:1508846528
Name:BUMPOUS, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:BUMPOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-583-8303
Mailing Address - Fax:502-584-0302
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 710
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-583-8303
Practice Address - Fax:502-584-0302
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30850207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100374010AMedicaid
KY64308505Medicaid
KY1051214OtherPASSPORT
KY1275071Medicare ID - Type Unspecified
KY64308505Medicaid