Healthcare Provider Details

I. General information

NPI: 1659443760
Provider Name (Legal Business Name): JIMMIE D BUSSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 RUSK ST
NEWTON TX
75966-3222
US

IV. Provider business mailing address

802 RUSK ST
NEWTON TX
75966-3222
US

V. Phone/Fax

Practice location:
  • Phone: 409-379-4357
  • Fax: 409-379-2661
Mailing address:
  • Phone: 409-379-4357
  • Fax: 409-379-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD4393
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: