Provider Demographics
NPI:1366439846
Name:BUSHYHEAD, JAMES B III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:BUSHYHEAD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 MINOR AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2120
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-576-3802
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-386-9605
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00013282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8152340Medicaid
WA5891740001OtherDME
WA49321OtherL & I
WABU5332OtherREGENCE
A04188Medicare UPIN