=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265896567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARIN L BUSH, D.O., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2016
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3101 N FEDERAL HWY SUITE 201
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33306-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-816-1301
-----------------------------------------------------
Fax | 954-840-8254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3101 N FEDERAL HWY SUITE 201
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33306-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-816-1301
-----------------------------------------------------
Fax | 954-840-8254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DARIN L BUSH
-----------------------------------------------------
Credential | D.O,
-----------------------------------------------------
Telephone | 954-816-1301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | OS8691
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------