Provider Demographics
NPI:1033668165
Name:MANUEL BUSTAMANTE M.D. P.A.
Entity Type:Organization
Organization Name:MANUEL BUSTAMANTE M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-298-1285
Mailing Address - Street 1:3369 PINE RIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3932
Mailing Address - Country:US
Mailing Address - Phone:239-298-1285
Mailing Address - Fax:
Practice Address - Street 1:3369 PINE RIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3932
Practice Address - Country:US
Practice Address - Phone:239-298-1285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty