Provider Demographics
NPI:1922065333
Name:BUMPERS, PAUL MCCONNELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MCCONNELL
Last Name:BUMPERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 S 54TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8169
Mailing Address - Country:US
Mailing Address - Phone:479-271-7077
Mailing Address - Fax:479-271-7035
Practice Address - Street 1:2100 S 54TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8169
Practice Address - Country:US
Practice Address - Phone:479-271-7077
Practice Address - Fax:479-271-7035
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6578208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE02944Medicare UPIN
AR115598001Medicaid
AR52857Medicare ID - Type Unspecified