Provider Demographics
NPI:1467415174
Name:BUSCH, HEIDI BYERS (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:BYERS
Last Name:BUSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:SUITE C-204
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-634-3376
Mailing Address - Fax:760-634-7955
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE C-204
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-634-3376
Practice Address - Fax:760-634-7955
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51650207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C516500Medicaid
CAI15780Medicare UPIN
CA00C516500Medicaid