Healthcare Provider Details

I. General information

NPI: 1275859910
Provider Name (Legal Business Name): RYAN WILLIAM BUSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

3709 144TH ST
URBANDALE IA
50323-2050
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-2667
  • Fax:
Mailing address:
  • Phone: 770-316-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number43187
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43187
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: