Provider Demographics
NPI:1720001241
Name:BUSCH, EDWARD LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEONARD
Last Name:BUSCH
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 1:11650 CALLE PARACHO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3313
Mailing Address - Country:US
Mailing Address - Phone:858-521-0443
Mailing Address - Fax:
Practice Address - Street 1:8810 RIO SAN DIEGO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1622
Practice Address - Country:US
Practice Address - Phone:619-400-5026
Practice Address - Fax:619-400-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC94411208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery