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NPI Code Detail

MEDICARE: JONATHAN K BUSHMAN DO

MEDICARE: JONATHAN K BUSHMAN DO
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 Physician5032OK

General Provider Information

NPI Number : 1508182619
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN K BUSHMAN DO
Provider Business Mailing Address
First Line : 822 W RANDOLPH AVE
Second Line :
City : ENID
State : OK
Zip : 73701-3834
Country : US
Telephone Number : 580-599-0272
Fax Number : 580-603-8602
Provider Business Practice Location Address
First Line : 822 W RANDOLPH AVE
Second Line :
City : ENID
State : OK
Zip : 73701-3834
Country : US
Telephone Number : 580-599-0272
Fax Number : 580-603-8602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2010
Last Update Date : 09/19/2021

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