MEDICARE: DR. RUSSEL ARNOLD BUZARD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A4436	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB237649	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1003884552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSEL ARNOLD BUZARD D.O.

Provider Business Mailing Address
First Line	:	306 W EL NORTE PKWY
Second Line	:	SUITE S
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1960
Country	:	US
Telephone Number	:	760-746-3703
Fax Number	:	760-746-5313

Provider Business Practice Location Address
First Line	:	306 W EL NORTE PKWY
Second Line	:	SUITE S
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1960
Country	:	US
Telephone Number	:	760-746-3703
Fax Number	:	760-746-5313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	11/18/2015

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