Healthcare Provider Details

I. General information

NPI: 1033738596
Provider Name (Legal Business Name): ROBERTO ESTEBAN BUSTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 FOX RD STE 401
VAN WERT OH
45891-3406
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 419-238-4909
  • Fax: 419-238-9615
Mailing address:
  • Phone: 614-788-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.154963
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: