Provider Demographics
NPI:1659443760
Name:BUSSEY, JIMMIE D (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:D
Last Name:BUSSEY
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 1:802 RUSK ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:TX
Mailing Address - Zip Code:75966-3222
Mailing Address - Country:US
Mailing Address - Phone:409-379-4357
Mailing Address - Fax:409-379-2661
Practice Address - Street 1:802 RUSK ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:TX
Practice Address - Zip Code:75966-3222
Practice Address - Country:US
Practice Address - Phone:409-379-4357
Practice Address - Fax:409-379-2661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
74238OtherBOON CHAPMAN
00900OtherCHRISTIAN FIDELITY
41041OtherFEDERATED INS
TX60054OtherAETNA
TCUCHOtherCBCA
61271OtherPRINCIPAL LIFE
87265OtherBENESIGHT
87726OtherUNITED
61101OtherHUMANA
87043OtherFIRST HEALTH
TX84980OtherBLUE CROSS BLUE SHIELD
80314OtherUNICARE
35196OtherCONSECO
4405AOtherGEHA
62308OtherCIGNA
80705OtherGREAT WEST
91151OtherSTERLING
87726OtherUNITED
TX00498FMedicare ID - Type Unspecified