Provider Demographics
NPI:1356354187
Name:BUSH, DAVID KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
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 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-324-4745
Mailing Address - Fax:606-324-4941
Practice Address - Street 1:613 23RD ST. SUITE 230
Practice Address - Street 2:MEDICAL PLAZA B
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-324-4745
Practice Address - Fax:606-324-4941
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26723207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY642672Medicaid
KY64267230Medicaid
WV0086359000Medicaid
OH0976261Medicaid
OH0976261Medicaid
WV0086359000Medicaid
KY64267230Medicaid
KY642672Medicaid