Provider Demographics
NPI:1639589781
Name:BUSHYHEAD, DANIEL W (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:BUSHYHEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 290
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3067
Mailing Address - Country:US
Mailing Address - Phone:206-431-9771
Mailing Address - Fax:206-431-5484
Practice Address - Street 1:16233 SYLVESTER RD SW STE 290
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3067
Practice Address - Country:US
Practice Address - Phone:206-431-9771
Practice Address - Fax:206-431-5484
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5134207RG0100X
WAMD60742811207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2082890Medicaid