Provider Demographics
NPI:1003884552
Name:BUZARD, RUSSEL ARNOLD (DO)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:ARNOLD
Last Name:BUZARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:306 W EL NORTE PKWY
Mailing Address - Street 2:SUITE S
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1960
Mailing Address - Country:US
Mailing Address - Phone:760-746-3703
Mailing Address - Fax:760-746-5313
Practice Address - Street 1:306 W EL NORTE PKWY
Practice Address - Street 2:SUITE S
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1960
Practice Address - Country:US
Practice Address - Phone:760-746-3703
Practice Address - Fax:760-746-5313
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB237649OtherMEDICARE PTAN
CACB237649OtherMEDICARE PTAN