Provider Demographics
NPI:1245216423
Name:BUSTAMANTE, JULIA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ANNE
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-358-4000
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4000
Practice Address - Fax:210-567-0083
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3058207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123389201Medicaid
TX83862KOtherBCBS
TX123389207Medicaid
TX123389208Medicaid
TX123389206Medicaid
TX050064830OtherRAILROAD
TX123389201Medicaid
TX83862KOtherBCBS
TX123389206Medicaid
TX123389208Medicaid
TX361462YK00Medicare PIN
E71598Medicare UPIN