Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS8691 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OS8691 | FL |
NPI | 1023026127 |
---|---|
Provider Name | Mr. Darin L Bush |
First Address | Oakland Park, FL 33306-1018 |
Second Address | Oakland Park, FL 33306-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 31/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92245 | (02) |