Provider Demographics
NPI:1174603211
Name:BUSHMAN, JEFFERY BURL (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:BURL
Last Name:BUSHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:900 W SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1017
Mailing Address - Country:US
Mailing Address - Phone:520-384-4421
Mailing Address - Fax:520-384-4645
Practice Address - Street 1:903 N BOWIE AVE
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1145
Practice Address - Country:US
Practice Address - Phone:520-384-4291
Practice Address - Fax:520-384-5175
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080033326OtherPALMETTO GBA RR MEDICARE
AZ080033326OtherPALMETTO GBA RR MEDICARE