Healthcare Provider Details

I. General information

NPI: 1386664209
Provider Name (Legal Business Name): RUSSELL BUESING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7987 S CLAYTON CIR
CENTENNIAL CO
80122-3481
US

IV. Provider business mailing address

7987 S CLAYTON CIR
CENTENNIAL CO
80122-3481
US

V. Phone/Fax

Practice location:
  • Phone: 303-807-3093
  • Fax:
Mailing address:
  • Phone: 303-807-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5443
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: