Provider Demographics
NPI:1518055847
Name:BUMGARNER, DONALD L (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:BUMGARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JACK FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-4586
Mailing Address - Country:US
Mailing Address - Phone:712-246-7400
Mailing Address - Fax:712-246-7334
Practice Address - Street 1:1 JACK FOSTER DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-4586
Practice Address - Country:US
Practice Address - Phone:712-246-7400
Practice Address - Fax:712-246-7334
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA03515Medicare UPIN