Provider Demographics
NPI:1780687889
Name:BUSH, STEVEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:BUSH
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:PO BOX 911057
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1057
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6640
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-385-4746
Practice Address - Fax:970-259-5787
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26605174400000X
NM79-1372085R0001X
CODR.00266052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00078763Medicaid
CO01266055Medicaid
UTT0009Medicaid
NM00078763Medicaid
COBU38558OtherBLUE CROSS OF COLORADO
NMNM000470OtherBLUE CROSS OF NEW MEXICO
CO300067108Medicare ID - Type UnspecifiedRAILROAD MEDICARE
D43066Medicare UPIN
UTT0009Medicaid