Healthcare Provider Details

I. General information

NPI: 1477651925
Provider Name (Legal Business Name): MUSHTAQ A BUKHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107B MICA AVE
MORGANTON NC
28655-8135
US

IV. Provider business mailing address

107B MICA AVE
MORGANTON NC
28655-8135
US

V. Phone/Fax

Practice location:
  • Phone: 828-437-7702
  • Fax: 828-437-7930
Mailing address:
  • Phone: 828-437-7702
  • Fax: 828-437-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: