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NPI Code Detail

MEDICARE: JEROME L BUSHNELL MD

MEDICARE: JEROME L BUSHNELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD00017470WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080067829OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2B870OTHERWABLUE SHIELD
30039581OTHERWALABOR & INDUSTRY
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5US0818823OTHERWAAETNA/USHC PCP
6US4119870OTHERWAAETNA/USHC SPECIALIST

General Provider Information

NPI Number : 1033149307
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME L BUSHNELL MD
Provider Business Mailing Address
First Line : 1100 OLIVE WAY MSC M4-PA
Second Line :
City : SEATTLE
State : WA
Zip : 98101-1873
Country : US
Telephone Number : 206-515-5811
Fax Number :
Provider Business Practice Location Address
First Line : 100 NE GILMAN BLVD
Second Line :
City : ISSAQUAH
State : WA
Zip : 98027-2925
Country : US
Telephone Number : 425-557-8000
Fax Number : 425-557-8014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 01/25/2011

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