Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036117250 | IL |
N | 207P00000X | Emergency Physician | R7913 | MO |
Y | 207PE0004X | Emergency Medical Services | R7913 | MO |
N | 2086S0127X | Trauma Surgeon | R7913 | MO |
N | 2086S0129X | Vascular Surgeon | R7913 | MO |
NPI | 1053303636 |
---|---|
Provider Name | Dr. Carl E. Bussmann |
First Address | Saint Louis, MO 63141-5803 |
Second Address | Saint Louis, MO 63136-6119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 26/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201656410 | (05) | IL |
201656410 | (05) | MO |
A11200 | (02) |