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General NPI Number Information
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NPI Number | 1720048861
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Entity Type | Individual
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Provider Name | STEPHEN D BUSH MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 939 CAROLINE ST # 3E
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City | PORT ANGELES
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State | WA
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Zip | 98362-3909
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Country | US
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Telephone | 360-565-0999
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Fax | 360-452-7303
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | PORT ANGELES
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State | WA
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Zip | 98362
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Country | US
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Telephone | 360-565-0999
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Fax | 360-452-7303
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD00039458
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License Number State | WA
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