Provider Demographics
NPI:1619916236
Name:BUSHELL, DOUGLAS G (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:BUSHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 MONARCH BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6883
Mailing Address - Country:US
Mailing Address - Phone:702-328-7235
Mailing Address - Fax:
Practice Address - Street 1:6245 SHERIDAN DR
Practice Address - Street 2:SUITE 212
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4834
Practice Address - Country:US
Practice Address - Phone:716-204-4500
Practice Address - Fax:716-204-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3983207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services