MEDICARE: DR. ANGELA C BUSCH-DOBLE 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	OS7586	FL

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	:	1962494880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA C BUSCH-DOBLE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	2310 VILLAGE SQUARE PKWY STE 201
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-6409
Country	:	US
Telephone Number	:	904-264-6404
Fax Number	:	904-390-7455

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	09/16/2024

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Directions to “ DR. ANGELA C BUSCH-DOBLE D.O.” Practice Location

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