Healthcare Provider Details

I. General information

NPI: 1699751354
Provider Name (Legal Business Name): ROBERT C BUSSING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 PALM RIDGE RD
SANIBEL FL
33957-3201
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6990
  • Fax: 239-343-4247
Mailing address:
  • Phone: 239-395-6990
  • Fax: 239-343-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME139008
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-059045
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME139008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: