Provider Demographics
NPI:1740262757
Name:BUSHAN, NAGA S (MD)
Entity type:Individual
Prefix:DR
First Name:NAGA
Middle Name:S
Last Name:BUSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 54088
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-4088
Mailing Address - Country:US
Mailing Address - Phone:806-771-2400
Mailing Address - Fax:806-771-2400
Practice Address - Street 1:5220 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2862
Practice Address - Country:US
Practice Address - Phone:806-771-2400
Practice Address - Fax:806-771-7760
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7707207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11352237OtherCAQH NUMBER
TXCJ4139OtherRAILROAD MEDICARE
TXH7707OtherSTATE MEDICAL LICENSE
TXCJ4139OtherRAILROAD MEDICARE