Healthcare Provider Details

I. General information

NPI: 1346201704
Provider Name (Legal Business Name): TIMOTHY BUSCH PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE MEDICO STE A
SANTA FE NM
87505-4762
US

IV. Provider business mailing address

7300 RANCH RD. 2222 BLDG 1 STE 200
AUSTIN TX
78730-3255
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-6300
  • Fax: 505-557-6302
Mailing address:
  • Phone: 512-628-0465
  • Fax: 512-233-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2005-0055
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: