MEDICARE: DR. BRYAN BUSH 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD454660	PA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME117209	FL
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	26325	WV

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	174GK	OTHER	NC	BCBC
3	62349	OTHER	NY	ALBANY MEDICAL CENTER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730339599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN BUSH MD

Provider Business Mailing Address
First Line	:	2405 SE 17TH ST STE 201
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-9190
Country	:	US
Telephone Number	:	352-690-2171
Fax Number	:	352-690-2171

Provider Business Practice Location Address
First Line	:	1500 SE MAGNOLIA EXT STE 203
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-4461
Country	:	US
Telephone Number	:	352-629-1378
Fax Number	:	352-629-1406

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	01/26/2022

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Directions to “ DR. BRYAN BUSH MD” Practice Location

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