Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | OS7006 | FL |
NPI | 1063466811 |
---|---|
Provider Name | Dr. Robert George Busch |
First Address | Lake City, FL 32055-4880 |
Second Address | Lake City, FL 32055-4880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
377722700 | (05) | FL |
E45336 | (02) | FL |