Provider Demographics
NPI:1063030435
Name:BUS, BRADLEY S (PA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:BUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-851-1505
Mailing Address - Fax:775-851-1583
Practice Address - Street 1:5575 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2290
Practice Address - Country:US
Practice Address - Phone:775-851-1505
Practice Address - Fax:775-851-1583
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NVPA2508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant