Provider Demographics
NPI:1063466811
Name:BUSCH, ROBERT GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4601 W US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4880
Mailing Address - Country:US
Mailing Address - Phone:386-752-4189
Mailing Address - Fax:386-752-4213
Practice Address - Street 1:4601 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4880
Practice Address - Country:US
Practice Address - Phone:386-752-4189
Practice Address - Fax:386-752-4213
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7006208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377722700Medicaid
FLE45336Medicare UPIN
FL377722700Medicaid