Healthcare Provider Details

I. General information

NPI: 1003884552
Provider Name (Legal Business Name): RUSSEL ARNOLD BUZARD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W EL NORTE PKWY SUITE S
ESCONDIDO CA
92026-1960
US

IV. Provider business mailing address

306 W EL NORTE PKWY SUITE S
ESCONDIDO CA
92026-1960
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-3703
  • Fax: 760-746-5313
Mailing address:
  • Phone: 760-746-3703
  • Fax: 760-746-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: