Provider Demographics
NPI:1760582159
Name:BUSHNELL, LAMAR J (MD)
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:J
Last Name:BUSHNELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3838 SAN DIMAS STREET
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2286
Mailing Address - Country:US
Mailing Address - Phone:661-327-8538
Mailing Address - Fax:661-327-5432
Practice Address - Street 1:145 N. BRENT STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2838
Practice Address - Country:US
Practice Address - Phone:805-643-2375
Practice Address - Fax:805-643-3511
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG81373208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
330003580OtherRAILROAD MEDICARE
F40527Medicare UPIN