Provider Demographics
NPI:1205817418
Name:BUZA, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:BUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE STE 5085
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3923
Mailing Address - Country:US
Mailing Address - Phone:503-561-7240
Mailing Address - Fax:503-561-7245
Practice Address - Street 1:875 OAK ST SE STE 5085
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3923
Practice Address - Country:US
Practice Address - Phone:503-561-7240
Practice Address - Fax:503-561-7245
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08457207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029934Medicaid
OR029934Medicaid
ORC92339Medicare UPIN