Healthcare Provider Details

I. General information

NPI: 1760471239
Provider Name (Legal Business Name): SUZANNE YANCEY BUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

IV. Provider business mailing address

5045 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2418
  • Fax: 850-416-2460
Mailing address:
  • Phone: 850-416-2418
  • Fax: 850-416-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME51930
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME51930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: