Healthcare Provider Details

I. General information

NPI: 1205814910
Provider Name (Legal Business Name): ROBERT LEE BUZARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N JESSE JAMES RD
EXCELSIOR SPRINGS MO
64024-1202
US

IV. Provider business mailing address

1010 N JESSE JAMES RD
EXCELSIOR SPRINGS MO
64024-1202
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-6722
  • Fax: 816-630-2471
Mailing address:
  • Phone: 816-630-6722
  • Fax: 816-630-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR6J43
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: