Provider Demographics
NPI:1821004987
Name:BUSSE, PAUL P (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:P
Last Name:BUSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1715 DEER TRACKS TRAIL
Mailing Address - Street 2:STE 130
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-821-5600
Mailing Address - Fax:314-821-2180
Practice Address - Street 1:11133 DUNN ROAD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-653-4300
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO348032085R0202X
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L40183OtherIL CARE
0006021895OtherIL BLUE
0360497781OtherIL CAID
25495OtherBLUE CHOICE
A12073OtherGATE WAY
1390OtherMO BLUE
2781OtherGHP
5493OtherHCARE USA
1082742OtherMC MCAID
300378OtherHLT PART
148419OtherH LINK
1609024OtherPH PLAN
A12073OtherGATE WAY