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General NPI Number Information
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NPI Number | 1598009722
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Entity Type | Organization
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Legal Business Name | JEFFERY B BUSHMAN DO PC
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Dates
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Enumeration Date | 11/10/2012
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Last Update Date | 11/10/2012
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Provider Practice Location Address
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Address Line | 905 N BOWIE AVE
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City | WILLCOX
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State | AZ
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Zip | 85643-1145
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Country | US
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Telephone | 520-384-4291
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Fax | 520-384-3055
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Provider Business Mailing Address
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Address Line | PO BOX 1115 905 N BOWIE AVE
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City | WILLCOX
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State | AZ
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Zip | 85644-1115
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Country | US
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Telephone | 520-384-4291
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Fax | 520-384-3055
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JEFFERY BURL BUSHMAN
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Credential | D. O.
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Telephone | 520-384-4291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 2338
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License Number State | AZ
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