Provider Demographics
NPI:1063471399
Name:BUSSEY, DENNIS L (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SE DESTINATION DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-6608
Mailing Address - Country:US
Mailing Address - Phone:515-986-4524
Mailing Address - Fax:515-986-4531
Practice Address - Street 1:101 SE DESTINATION DRIVE
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-6608
Practice Address - Country:US
Practice Address - Phone:515-986-4524
Practice Address - Fax:515-986-4531
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3188193Medicaid
IA1063471399Medicaid
IA080184194Medicare PIN
IA3188193Medicaid
IA719260404Medicare PIN
IAI6631Medicare PIN