Provider Demographics
NPI:1932140241
Name:BUSS, RANDALL W (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:W
Last Name:BUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6341
Mailing Address - Fax:239-343-6342
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-343-9960
Practice Address - Fax:239-343-9977
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53169208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME53169OtherMEDICAL LICENSE
P00145904OtherRAILROAD MEDICARE
3568049OtherAETNA HMO
FL254919100Medicaid
FL44351OtherBLUE SHIELD
7864548OtherAETNA PPO
FL44351OtherBLUE SHIELD