Provider Demographics
NPI:1760471239
Name:BUSH, SUZANNE YANCEY (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:YANCEY
Last Name:BUSH
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 1:5045 CARPENTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2521
Mailing Address - Country:US
Mailing Address - Phone:850-416-2418
Mailing Address - Fax:850-416-2460
Practice Address - Street 1:5045 CARPENTER CREEK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2521
Practice Address - Country:US
Practice Address - Phone:850-416-2418
Practice Address - Fax:850-416-2460
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51930207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59082808OtherBCBS AL
FLZ259OtherHEALTH FIRST NETWORK
FL4695751002OtherCIGNA
FLP00099337OtherMEDICARE RR
FL047127500Medicaid
FL4276628OtherAETNA
FL09853OtherBCBSFL
FL0706930OtherUNITED HEALTHCARE
FL4695751002OtherCIGNA
FL047127500Medicaid