MEDICARE: DR. JEREMY ALLEN BUSH 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	207L00000X	Anesthesiology Physician	E-6405	AR

General Provider Information

NPI Number	:	1235358565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY ALLEN BUSH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 583
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-0583
Country	:	US
Telephone Number	:	888-991-1101
Fax Number	:	903-787-5854

Provider Business Practice Location Address
First Line	:	3728 S PINNACLE HILLS PKWY
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8897
Country	:	US
Telephone Number	:	479-254-8508
Fax Number	:	479-282-1479

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	10/30/2024

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