Provider Demographics
NPI:1295790780
Name:BUSH, GARY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:EDWARD
Last Name:BUSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8500
Mailing Address - Country:US
Mailing Address - Phone:910-715-1010
Mailing Address - Fax:910-715-1926
Practice Address - Street 1:VA MEDICAL CENTER, MOUNTAIN HOME
Practice Address - Street 2:SIDNEY AND LAMONT ST
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-2829
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2015-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN17658207RG0300X
NC2015-00086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine