Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E-9487 | AR |
NPI | 1003234105 |
---|---|
Provider Name | Megan Elizabeth Busch |
First Address | Centerton, AR 72719-1225 |
Second Address | Centerton, AR 72719-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2014 |
Last Update Date | 12/07/2017 |