Provider Demographics
NPI:1942380431
Name:BUSH, TREVOR WRIGHT (MD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:WRIGHT
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 1:505 S BURG ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1313
Mailing Address - Country:US
Mailing Address - Phone:308-235-1966
Mailing Address - Fax:308-235-2403
Practice Address - Street 1:505 S BURG ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1313
Practice Address - Country:US
Practice Address - Phone:308-235-1966
Practice Address - Fax:308-235-2403
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7915A207Q00000X
NE24769207Q00000X
CO2119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine