Provider Demographics
NPI:1558306597
Name:BUSHNELL, JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 SE RIVERBOAT DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-1510
Mailing Address - Country:US
Mailing Address - Phone:772-905-9099
Mailing Address - Fax:
Practice Address - Street 1:5855 SE RIVERBOAT DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-1510
Practice Address - Country:US
Practice Address - Phone:772-905-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME93138OtherMD