Basic Information
| Provider Information | |||||||||
| NPI: | 1043310337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BRENT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568016049 | ||||||||
| FaxNumber: | 2568016218 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 E BROOKLYN ST | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370963515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315892104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 31181 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.