MEDICARE: GEORGE C BOBUSTUC MD

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	207RX0202X	Medical Oncology Physician	56643	WI
2	2084N0400X	Neurology Physician	56643	WI
3	2084N0400X	Neurology Physician	K8716	TX
4	2084N0400X	Neurology Physician	036107297	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790760676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE C BOBUSTUC MD

Provider Business Mailing Address
First Line	:	9715 BURNET RD BLDG 7
Second Line	:	STE.200
City	:	AUSTIN
State	:	TX
Zip	:	78758-5215
Country	:	US
Telephone Number	:	512-505-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 E MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-1449
Country	:	US
Telephone Number	:	512-505-5500
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	06/06/2022

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