Provider Demographics
NPI:1174578926
Name:BUSSEY, RANDY M (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:M
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 W 13TH ST
Mailing Address - Street 2:101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4816
Mailing Address - Country:US
Mailing Address - Phone:970-348-0020
Mailing Address - Fax:970-348-0055
Practice Address - Street 1:5890 W 13TH ST
Practice Address - Street 2:101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4816
Practice Address - Country:US
Practice Address - Phone:970-348-0020
Practice Address - Fax:970-348-0055
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22988207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01229889Medicaid
COD24188Medicare UPIN
COCO40809Medicare PIN
CO01229889Medicaid