1407193337 NPI number — DANIEL E. BUSTOS, M.D., P.C.

Table of content: (NPI 1407193337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407193337 NPI number — DANIEL E. BUSTOS, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL E. BUSTOS, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407193337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10791
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-868-6020
Provider Business Mailing Address Fax Number:
888-947-3843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 MEDICAL CENTER PKWY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-2248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-868-6020
Provider Business Practice Location Address Fax Number:
888-947-3846
Provider Enumeration Date:
01/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUSTOS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
EDUARDO
Authorized Official Title or Position:
M.D./OWNER
Authorized Official Telephone Number:
541-868-6020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  41455 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)