Provider Demographics
NPI:1154637759
Name:BUSSCHER, GEOFFREY WINSTON
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:WINSTON
Last Name:BUSSCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXPEDITIONARY HEALTH SERVICES BLDG 116
Mailing Address - Street 2:3985 CUMMINGS RD. SUITE 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-0001
Mailing Address - Country:US
Mailing Address - Phone:619-556-1436
Mailing Address - Fax:
Practice Address - Street 1:EXPEDITIONARY HEALTH SERVICES BLDG 116
Practice Address - Street 2:3985 CUMMINGS RD. SUITE 4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-0001
Practice Address - Country:US
Practice Address - Phone:619-556-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman