Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 10761618-1205 | UT |
NPI | 1003070111 |
---|---|
Provider Name | Dr. Robert Joel Bush |
First Address | American Fork, UT 84003-2590 |
Second Address | American Fork, UT 84003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 16/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD 000 | (02) | GA |