Healthcare Provider Details

I. General information

NPI: 1740677426
Provider Name (Legal Business Name): WILLIAM BRIAN BUSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 PAPERMILL DR. SUITE 200
KNOXVILLE TN
37909-1907
US

IV. Provider business mailing address

4707 PAPERMILL DR. SUITE 200
KNOXVILLE TN
37909-1907
US

V. Phone/Fax

Practice location:
  • Phone: 865-602-7983
  • Fax: 865-602-7984
Mailing address:
  • Phone: 865-602-7983
  • Fax: 865-602-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number55390
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: