Provider Demographics
NPI:1982872099
Name:JOHN R STUMP MD
Entity Type:Organization
Organization Name:JOHN R STUMP MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-424-0523
Mailing Address - Street 1:200 KONA CIR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5396
Mailing Address - Country:US
Mailing Address - Phone:302-424-0523
Mailing Address - Fax:302-424-2415
Practice Address - Street 1:200 KONA CIR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5396
Practice Address - Country:US
Practice Address - Phone:302-424-0523
Practice Address - Fax:302-424-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003146332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000168701Medicaid
DE0000168701Medicaid
DE0516920001Medicare NSC