Provider Demographics
NPI:1770774440
Name:BUMGARNER, JAYNE LORA OPENA (MD)
Entity type:Individual
Prefix:
First Name:JAYNE LORA
Middle Name:OPENA
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYNE LORA
Other - Middle Name:LAGUTAN
Other - Last Name:OPENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST MAILSTOP 400N
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4801 S CLIFF AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7015
Practice Address - Country:US
Practice Address - Phone:816-251-5200
Practice Address - Fax:816-251-5299
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36702208M00000X
MO2010023241208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH74000017Medicare PIN