=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063637692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOWARD M BUSCH DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 02/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12977 SOUTHERN BLVD BLDG 5
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-798-8184
-----------------------------------------------------
Fax | 561-793-2588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12977 SOUTHERN BLVD BLDG 5
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-798-8184
-----------------------------------------------------
Fax | 561-793-2588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOWARD M BUSCH
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 561-747-1987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------