Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | DPM 471 | TN |
N | 213ES0103X | Foot & Ankle Surgery | DPM 471 | TN |
NPI | 1417952581 |
---|---|
Provider Name | Dr. Tod Raymond Bushman |
First Address | Hermitage, TN 37076-2054 |
Second Address | Goodlettsville, TN 37072-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3376588 | (05) | TN |
6083425 | BCBS TN (01) | TN |
Q019425 | (05) | TN |
U60283 | (02) | TN |