MEDICARE: DR. ROBERT LEE BUSHMAN D.P.M.,R.N.

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	213E00000X	Podiatrist	000373	MO

General Provider Information

NPI Number	:	1760748420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE BUSHMAN D.P.M.,R.N.

Provider Business Mailing Address
First Line	:	10016 OFFICE CENTER AVE
Second Line	:	SUITE 100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1468
Country	:	US
Telephone Number	:	314-720-0855
Fax Number	:	314-735-4335

Provider Business Practice Location Address
First Line	:	10016 OFFICE CENTER AVE
Second Line	:	SUITE 100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1468
Country	:	US
Telephone Number	:	314-720-0855
Fax Number	:	314-735-4335

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

Provider Enumeration Date	:	04/07/2012
Last Update Date	:	10/08/2012

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