Provider Demographics
NPI:1982665543
Name:MAGPANTAY, JOHN RICO BUSTAMANTE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN RICO
Middle Name:BUSTAMANTE
Last Name:MAGPANTAY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:INTERNAL MEDICINE CLINIC
Mailing Address - City:FT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-1022
Mailing Address - Fax:571-231-1155
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:INTERNAL MEDICINE CLINIC
Practice Address - City:FT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-1022
Practice Address - Fax:571-231-1155
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-12-07
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Provider Licenses
StateLicense IDTaxonomies
VA0101238814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine