Individual
JOHN PHILLIP BUSHKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
127 MCCLANAHAN ST SW, SUITE 300, ROANOKE, VA 24014-1728
(540) 982-8204
(540) 224-1059
Mailing address
127 MCCLANAHAN ST SW, SUITE 300, ROANOKE, VA 24014-1728
(540) 982-8204
(540) 224-1059
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101017672
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5836018
—
VA
05
—
5848911
—
VA
01
—
CI6105
RR MEDICARE GROUP
VA
Enumeration date
08/02/2005
Last updated
08/11/2011
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