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General NPI Number Information
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NPI Number | 1538197074
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Entity Type | Individual
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Provider Name | JEFFREY L BUSH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 46 BARRA RD STE 103
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City | BIDDEFORD
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State | ME
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Zip | 04005-9461
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Country | US
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Telephone | 207-286-1126
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR
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City | BIDDEFORD
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State | ME
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Zip | 04005-9422
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Country | US
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Telephone |
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Fax | 207-795-0260
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 017054
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 017054
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License Number State | ME
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