MEDICARE: WILLIAM STEPHEN BUSH, M.D., A MEDICAL CORPORATION

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578557054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM STEPHEN BUSH, M.D., A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	6601 WHITE FEATHER RD
Second Line	:	DEPT OF PATHOLOGY
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-6607
Country	:	US
Telephone Number	:	760-366-6273
Fax Number	:	760-366-6461

Provider Business Practice Location Address
First Line	:	6601 WHITE FEATHER RD
Second Line	:	DEPT OF PATHOLOGY
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-6607
Country	:	US
Telephone Number	:	760-366-6273
Fax Number	:	760-366-6461

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM S BUSH
Credential	:	M.D.
Telephone Number	:	760-366-6273

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	01/30/2014

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