Healthcare Provider Details

I. General information

NPI: 1780687889
Provider Name (Legal Business Name): STEVEN E BUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST SUITE 100
DURANGO CO
81301-7306
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-4746
  • Fax: 970-259-5787
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number26605
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number79-137
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0026605
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: