Provider Demographics
NPI:1114183712
Name:BUSHARD, JANNETTE (DO)
Entity Type:Individual
Prefix:
First Name:JANNETTE
Middle Name:
Last Name:BUSHARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANNETTE
Other - Middle Name:
Other - Last Name:BUSHARD OLMSTED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:2530 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4317
Practice Address - Country:US
Practice Address - Phone:940-898-1477
Practice Address - Fax:940-382-4091
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FT755OtherBCBS
TX354404101Medicaid
TX354404102OtherCSHCN
TX474887YKUTMedicare PIN