Provider Demographics
NPI:1407924939
Name:BUSSEY, STUART (MD, AME)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:MD, AME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 BOULEVARD WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1186
Mailing Address - Country:US
Mailing Address - Phone:925-934-7691
Mailing Address - Fax:925-934-0569
Practice Address - Street 1:1181 BOULEVARD WAY
Practice Address - Street 2:SUITE B
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1186
Practice Address - Country:US
Practice Address - Phone:925-934-7691
Practice Address - Fax:925-934-0569
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G395900Medicare ID - Type Unspecified
CAA47867Medicare UPIN