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General NPI Number Information
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NPI Number | 1619262466
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Entity Type | Individual
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Provider Name | BRENT BUSHMAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 2200 S HOUGHTON RD
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City | TUCSON
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State | AZ
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Zip | 85748-7632
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Country | US
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Telephone | 205-436-1005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3570
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City | SALT LAKE CITY
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State | UT
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Zip | 84110-3570
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Country | US
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Telephone | 801-727-2056
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Fax | 770-701-6675
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 28680
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 76628
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 11936443-1205
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License Number State | UT
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