Healthcare Provider Details

I. General information

NPI: 1386608628
Provider Name (Legal Business Name): JONAS GUINTO BUSTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 NORTH B ST
HERINGTON KS
67449
US

IV. Provider business mailing address

4600 COLLEGE BLVD STE 103
OVERLAND PARK KS
66211-1606
US

V. Phone/Fax

Practice location:
  • Phone: 785-258-3705
  • Fax: 785-258-3706
Mailing address:
  • Phone: 913-215-5008
  • Fax: 913-297-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0416653
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0416653
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: