MEDICARE: DR. JAMES WAYNE TERBUSH MD

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	207Q00000X	Family Medicine Physician	24102	CO

General Provider Information

NPI Number	:	1821078858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WAYNE TERBUSH MD

Provider Business Mailing Address
First Line	:	1675 GARDEN OF THE GODS RD
Second Line	:	SUITE 2044
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9444
Country	:	US
Telephone Number	:	719-578-3258
Fax Number	:	719-575-8664

Provider Business Practice Location Address
First Line	:	1675 GARDEN OF THE GODS RD
Second Line	:	SUITE 2044
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9444
Country	:	US
Telephone Number	:	719-578-3258
Fax Number	:	719-575-8664

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/03/2015

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