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General NPI Number Information
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NPI Number | 1154711513
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Entity Type | Individual
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Provider Name | EDUARDO ALEJANDRO BUSTAMANTE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | PO BOX 1520
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City | WOODRUFF
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State | WI
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Zip | 54568-1520
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Country | US
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Telephone | 715-356-2262
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Fax | 715-356-2257
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Provider Business Mailing Address
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Address Line | PO BOX 1520
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City | WOODRUFF
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State | WI
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Zip | 54568-1520
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Country | US
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Telephone | 715-356-2262
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Fax | 715-356-2257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME144452
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 83664-20
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License Number State | WI
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