Provider Demographics
NPI:1265674196
Name:BUSH-COAXUM, SHARON MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MARIE
Last Name:BUSH-COAXUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6902
Mailing Address - Country:US
Mailing Address - Phone:334-671-9445
Mailing Address - Fax:
Practice Address - Street 1:1155 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3921
Practice Address - Country:US
Practice Address - Phone:334-671-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL152783Medicaid