MEDICARE: DR. STEPHEN HAROLD BUSH II M.D.

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
1	207V00000X	Obstetrics & Gynecology Physician	ME116789	FL
2	207VX0201X	Gynecologic Oncology Physician	26934	WV

General Provider Information

NPI Number	:	1083875710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN HAROLD BUSH II M.D.

Provider Business Mailing Address
First Line	:	1 COURTNEY DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2696
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 COURTNEY DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2696
Country	:	US
Telephone Number	:	304-925-4200
Fax Number	:	304-925-0483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	09/07/2016

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