Provider Demographics
NPI:1932108867
Name:BUSH, JAMES ESTES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ESTES
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 1:3805 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3019
Mailing Address - Country:US
Mailing Address - Phone:619-296-1519
Mailing Address - Fax:
Practice Address - Street 1:3805 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3019
Practice Address - Country:US
Practice Address - Phone:619-296-1519
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-34666207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C346661Medicaid
A35697Medicare UPIN
CAC34666AMedicare ID - Type Unspecified