MEDICARE: MRS. DANA BRASFIELD BUSSEY

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	2080P0214X	Pediatric Pulmonology Physician	4130	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80640	OTHER	AL	BLUE CROSS
2	51537085	OTHER		BCBS

General Provider Information

NPI Number	:	1407950132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA BRASFIELD BUSSEY

Provider Business Mailing Address
First Line	:	2660 10TH AVENUE SOUTH
Second Line	:	STE 701
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1628
Country	:	US
Telephone Number	:	205-776-8789
Fax Number	:	205-776-8792

Provider Business Practice Location Address
First Line	:	2660 10TH AVENUE SOUTH
Second Line	:	STE 701
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1628
Country	:	US
Telephone Number	:	205-776-8789
Fax Number	:	205-776-8792

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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