Provider Demographics
NPI:1760663470
Name:BUSCH, PETER
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BUSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39275 LIBERTY ST
Mailing Address - Street 2:D-12
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1519
Mailing Address - Country:US
Mailing Address - Phone:510-739-1945
Mailing Address - Fax:510-739-6963
Practice Address - Street 1:39275 LIBERTY ST
Practice Address - Street 2:D-12
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1519
Practice Address - Country:US
Practice Address - Phone:510-739-1945
Practice Address - Fax:510-739-6963
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator