Provider Demographics
NPI:1760489504
Name:BUCSHON, LARRY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DEAN
Last Name:BUCSHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 ST MARYS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8005
Mailing Address - Country:US
Mailing Address - Phone:812-473-2642
Mailing Address - Fax:812-474-4458
Practice Address - Street 1:901 ST MARYS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8005
Practice Address - Country:US
Practice Address - Phone:812-473-2642
Practice Address - Fax:812-474-4458
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01048423A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64883226Medicaid
G11928Medicare UPIN
IN845900SMedicare ID - Type Unspecified
KY0223317Medicare ID - Type Unspecified