MEDICARE: JAMES R BUSCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	27662	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780764357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R BUSCH MD

Provider Business Mailing Address
First Line	:	1702 MEDICAL PARK DR W
Second Line	:	PO BOX 3409
City	:	WILSON
State	:	NC
Zip	:	27893-2705
Country	:	US
Telephone Number	:	252-243-7944
Fax Number	:	252-243-6097

Provider Business Practice Location Address
First Line	:	1702 MEDICAL PARK DR W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-2705
Country	:	US
Telephone Number	:	252-243-7944
Fax Number	:	252-243-6097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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