Healthcare Provider Details

I. General information

NPI: 1568471795
Provider Name (Legal Business Name): GUALBERTO D BUZON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVENUE 3175 W PROFESSIONAL DRIVE
BAY CITY MI
48708
US

IV. Provider business mailing address

915 WASHINGTON AVENUE SUITE 323
BAY CITY MI
48708
US

V. Phone/Fax

Practice location:
  • Phone: 989-891-9050
  • Fax: 989-891-9070
Mailing address:
  • Phone: 989-891-9050
  • Fax: 989-891-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301032569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: