MEDICARE: CHARLES BUSER

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	208D00000X	General Practice Physician	MD00015169	WA
2	207Q00000X	Family Medicine Physician	MD00015169	WA

General Provider Information

NPI Number	:	1790850337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BUSER

Provider Business Mailing Address
First Line	:	3000 LIMITED LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-2704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 LIMITED LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-2704
Country	:	US
Telephone Number	:	360-357-9392
Fax Number	:	360-528-3049

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	11/22/2019

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Directions to “ CHARLES BUSER ” Practice Location

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