Provider Demographics
NPI:1114951563
Name:BUSH, JEFF W (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:W
Last Name:BUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E. BROAD ST.
Mailing Address - Street 2:STE A
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027
Mailing Address - Country:US
Mailing Address - Phone:334-687-3836
Mailing Address - Fax:334-687-0725
Practice Address - Street 1:617 EAST BROAD STREET
Practice Address - Street 2:STE A
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027
Practice Address - Country:US
Practice Address - Phone:334-687-3836
Practice Address - Fax:334-687-0725
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026719Medicare ID - Type Unspecified
ALF95820Medicare UPIN