Healthcare Provider Details

I. General information

NPI: 1437224649
Provider Name (Legal Business Name): JAMES F BUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 LA MESA DR
FORT COLLINS CO
80524-9528
US

IV. Provider business mailing address

3817 LA MESA DR
FORT COLLINS CO
80524-9528
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-2447
  • Fax:
Mailing address:
  • Phone: 970-493-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number25049
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: