Healthcare Provider Details

I. General information

NPI: 1063471399
Provider Name (Legal Business Name): DENNIS L BUSSEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SE DESTINATION DRIVE
GRIMES IA
50111-6608
US

IV. Provider business mailing address

101 SE DESTINATION DR
GRIMES IA
50111-6608
US

V. Phone/Fax

Practice location:
  • Phone: 515-986-4524
  • Fax: 515-986-4531
Mailing address:
  • Phone: 515-986-4524
  • Fax: 515-986-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3318
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: