Provider Demographics
NPI:1184745010
Name:BUSBY, JAY
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:BUSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:D
Other - Last Name:BUSBY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2106 LOOP RD STE B
Mailing Address - Street 2:PO BOX 1575
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-3343
Mailing Address - Country:US
Mailing Address - Phone:318-435-3771
Mailing Address - Fax:318-435-7233
Practice Address - Street 1:2106 LOOP RD
Practice Address - Street 2:SUITE B
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3342
Practice Address - Country:US
Practice Address - Phone:318-435-3771
Practice Address - Fax:318-435-7233
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology