Healthcare Provider Details

I. General information

NPI: 1477844405
Provider Name (Legal Business Name): BRIAN CAMERON BUDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N TUSTIN AVE SUITE A
SANTA ANA CA
92705-3605
US

IV. Provider business mailing address

2973 PENMAN
TUSTIN CA
92782-3314
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-0800
  • Fax:
Mailing address:
  • Phone: 714-785-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA127794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: