Healthcare Provider Details

I. General information

NPI: 1811404510
Provider Name (Legal Business Name): BENJAMIN BUSFIELD MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 COUNTRY HILLS DR STE B
ANTIOCH CA
94509-7436
US

IV. Provider business mailing address

3527 MT DIABLO BLVD STE 449
LAFAYETTE CA
94549-3815
US

V. Phone/Fax

Practice location:
  • Phone: 415-310-7634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA82241
License Number StateCA

VIII. Authorized Official

Name: DR. BENJAMIN BUSFIELD
Title or Position: PRESIDENT
Credential: MD
Phone: 415-310-7634