Healthcare Provider Details

I. General information

NPI: 1497703730
Provider Name (Legal Business Name): ROBERT JAMES BUZZINI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N CURTIS ROAD STE 300
BOISE ID
83706
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3330
  • Fax: 208-367-3331
Mailing address:
  • Phone: 208-367-3330
  • Fax: 208-367-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA276
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: