Individual
JEROME L BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NE GILMAN BLVD, ISSAQUAH, WA 98027-2925
(425) 557-8000
(425) 557-8014
Mailing address
1100 OLIVE WAY MSC M4-PA, SEATTLE, WA 98101-1873
(206) 515-5811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00017470
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039581
LABOR & INDUSTRY
WA
01
—
080067829
RAILROAD MEDICARE
—
05
—
175072
—
WA
01
—
B870
BLUE SHIELD
WA
01
—
US0818823
AETNA/USHC PCP
WA
01
—
US4119870
AETNA/USHC SPECIALIST
WA
Enumeration date
07/03/2006
Last updated
01/25/2011
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