Provider Demographics
NPI:1508828641
Name:BUSTAMANTE, HANZY F (MD)
Entity Type:Individual
Prefix:
First Name:HANZY
Middle Name:F
Last Name:BUSTAMANTE
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:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BLDG B., #220
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-419-9016
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22429207R00000X
UT13166411-1205207R00000X
TXM1551208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175955703Medicaid
TX175955704Medicaid
TX1759557-02Medicaid
TX175955706Medicaid
TX175955701Medicaid
TX175955705Medicaid
TX175955707Medicaid
TXTXB155565Medicare PIN
TXP00797267Medicare PIN
TX175955705Medicaid
TX175955704Medicaid
TXP01149029Medicare PIN
TX1759557-02Medicaid
TX8L21550Medicare PIN
TX175955701Medicaid
TXTXB155566Medicare PIN
TX8D8201Medicare ID - Type Unspecified