Provider Demographics
NPI:1376501544
Name:BUSHKELL, LAWRENCE L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:L
Last Name:BUSHKELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5718
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:865-544-0480
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN13438207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376258Medicaid
TN0015500OtherBLUE CROSS
TN4034509OtherAETNA
TNB04363Medicare UPIN
TN3376258Medicaid