Provider Demographics
NPI:1730339599
Name:BUSH, BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
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 1:2405 SE 17TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9190
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-2171
Practice Address - Street 1:1500 SE MAGNOLIA EXT STE 203
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4461
Practice Address - Country:US
Practice Address - Phone:352-629-1378
Practice Address - Fax:352-629-1406
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454660208G00000X
FLME117209208G00000X
WV26325208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921751Medicaid
NC174GKOtherBCBC
NY62349OtherALBANY MEDICAL CENTER
NCNC90370322Medicare PIN
NC174GKOtherBCBC