Provider Demographics
NPI:1295805091
Name:BUSH, ROBERT ALFRED JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALFRED
Last Name:BUSH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2261 MARKET ST # 158
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1600
Mailing Address - Country:US
Mailing Address - Phone:415-621-8175
Mailing Address - Fax:
Practice Address - Street 1:17 BEAVER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1514
Practice Address - Country:US
Practice Address - Phone:415-621-8175
Practice Address - Fax:415-252-8131
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA23336208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23336OtherBLUE CROSS OF CALIFORNIA
CA00A233360Medicaid
CA00A233360OtherBLUE SHIELD OF CALIFORNIA
CAA23336OtherBLUE CROSS OF CALIFORNIA
CAA23488Medicare UPIN