Healthcare Provider Details

I. General information

NPI: 1568402303
Provider Name (Legal Business Name): JEFFREY C BUCHSBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 N MILO B SAMPSON LN
BLOOMINGTON IN
47408-1398
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 130
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-349-5074
  • Fax: 812-349-5046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD425677
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME103649
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01068408A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: