Individual
FREDERIC RANSOM BUSHNELL III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
909 SOUTH FAIR OAKS AVENUE, PASADENA, CA 91105-2625
(626) 389-9300
(626) 389-9336
Mailing address
SHRINERS HOSPITALS FOR CHILDREN, PO BOX 8500, PHILADELPHIA, PA 19178-8113
(813) 281-8478
(813) 281-8113
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A74349
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A743490
BLUE SHIELD
CA
05
—
00A743490
—
CA
01
—
00A743491
BLUE SHIELD
CA
Enumeration date
07/26/2006
Last updated
05/09/2018
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