MEDICARE: PAUL S BUSHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G3202	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710992862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL S BUSHART MD

Provider Business Mailing Address
First Line	:	PO BOX 26726
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-0726
Country	:	US
Telephone Number	:	512-407-8686
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	4315 JAMES CASEY ST STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3364
Country	:	US
Telephone Number	:	512-383-9752
Fax Number	:	512-406-7360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/23/2018

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Directions to “ PAUL S BUSHART MD” Practice Location

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