Provider Demographics
NPI:1295040582
Name:JEFF W BUSH, M.D,, FAMILY PRACTICE LLC.
Entity Type:Organization
Organization Name:JEFF W BUSH, M.D,, FAMILY PRACTICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-687-3836
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:36027-1710
Mailing Address - Country:US
Mailing Address - Phone:334-687-3836
Mailing Address - Fax:334-687-0725
Practice Address - Street 1:617 E BROAD ST
Practice Address - Street 2:STE A
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1710
Practice Address - Country:US
Practice Address - Phone:334-687-3836
Practice Address - Fax:334-687-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-98558OtherBCBS OF ALABAMA
AL26719Medicare UPIN