Provider Demographics
NPI:1568471795
Name:BUZON, GUALBERTO D (MD)
Entity Type:Individual
Prefix:
First Name:GUALBERTO
Middle Name:D
Last Name:BUZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-891-9050
Mailing Address - Fax:989-891-9070
Practice Address - Street 1:1900 COLUMBUS AVENUE
Practice Address - Street 2:3175 W PROFESSIONAL DRIVE
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-891-9050
Practice Address - Fax:989-891-9070
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010325692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4776856Medicaid
MI4736903Medicaid
MIPT19320003Medicare ID - Type Unspecified
B48327Medicare UPIN