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General NPI Number Information
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NPI Number | 1306008230
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Entity Type | Individual
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Provider Name | SCOTT BUSSOM P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 1050 SE MONTEREY RD STE 400
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-288-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 60 OLD NEW MILFORD RD STE 3E
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City | BROOKFIELD
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State | CT
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Zip | 06804-2414
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Country | US
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Telephone | 203-775-6205
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Fax | 203-775-2373
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2964
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9114250
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License Number State | FL
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