Provider Demographics
NPI:1760748420
Name:BUSHMAN, ROBERT LEE (DPM,RN)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:BUSHMAN
Suffix:
Gender:M
Credentials:DPM,RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10016 OFFICE CENTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1468
Mailing Address - Country:US
Mailing Address - Phone:314-720-0855
Mailing Address - Fax:314-735-4335
Practice Address - Street 1:10016 OFFICE CENTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1468
Practice Address - Country:US
Practice Address - Phone:314-720-0855
Practice Address - Fax:314-735-4335
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO000373213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist