Provider Demographics
NPI:1407193337
Name:DANIEL E. BUSTOS, M.D., P.C.
Entity Type:Organization
Organization Name:DANIEL E. BUSTOS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:BUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-868-6020
Mailing Address - Street 1:PO BOX 10791
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0016
Mailing Address - Country:US
Mailing Address - Phone:541-868-6020
Mailing Address - Fax:888-947-3843
Practice Address - Street 1:1725 MEDICAL CENTER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2248
Practice Address - Country:US
Practice Address - Phone:541-868-6020
Practice Address - Fax:888-947-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty