Provider Demographics
NPI:1326041450
Name:BUCHSBAUM, BRUCE LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEWIS
Last Name:BUCHSBAUM
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 1:501 SW 7TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4538
Mailing Address - Country:US
Mailing Address - Phone:515-243-3161
Mailing Address - Fax:515-243-5687
Practice Address - Street 1:501 SW 7TH ST
Practice Address - Street 2:STE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4538
Practice Address - Country:US
Practice Address - Phone:515-243-3161
Practice Address - Fax:515-243-5687
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-01-14
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
IA26401207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0049270Medicaid
IAA03754Medicare UPIN
IA26401Medicare ID - Type Unspecified