Provider Demographics
NPI:1801858774
Name:BUGBEE, JOLYNN A (MD)
Entity type:Individual
Prefix:
First Name:JOLYNN
Middle Name:A
Last Name:BUGBEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 STONE PARK BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:605-937-5537
Mailing Address - Fax:
Practice Address - Street 1:2720 STONE PARK BLVD STE 335
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:605-937-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34271207R00000X
SD3845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE42128384924Medicaid
SD6000305Medicaid
IA18432OtherWELLMARK BCBS IA
SD6000303Medicaid
IA38362OtherWELLMARK BCBS IA HAWARDEN
SD6000303Medicaid
IAP00257093Medicare ID - Type UnspecifiedRR MEDICARE HAWARDEN
SD6000303Medicaid