Individual
GAVIN JOHN BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 W BROADWAY ST STE 320, MISSOULA, MT 59802-4003
(406) 329-5615
(406) 329-5606
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
(406) 329-5615
(406) 329-5606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-144296
MT
363A00000X
Physician Assistant
PA164984
OR
Other
Enumeration date
11/18/2013
Last updated
04/20/2025
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