Healthcare Provider Details

I. General information

NPI: 1790165348
Provider Name (Legal Business Name): MICHAEL BUZZARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 08/14/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUDLAGER 301
APO AE
09112
US

IV. Provider business mailing address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3555
  • Fax:
Mailing address:
  • Phone: 808-433-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29411
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: