Healthcare Provider Details

I. General information

NPI: 1366550808
Provider Name (Legal Business Name): EDWIN R BUSTER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST D-4
AUSTIN TX
78705
US

IV. Provider business mailing address

711 W 38TH ST D-4
AUSTIN TX
78705-1121
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-9627
  • Fax: 512-454-6310
Mailing address:
  • Phone: 512-454-9627
  • Fax: 512-454-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD0073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: