Provider Demographics
NPI:1396864047
Name:BUSSE, JOEL M (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:BUSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4031
Mailing Address - Country:US
Mailing Address - Phone:561-307-2771
Mailing Address - Fax:
Practice Address - Street 1:110 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4031
Practice Address - Country:US
Practice Address - Phone:561-307-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME929652085R0001X
GA0554752085R0001X
WI23932-0202085R0001X
TNMD402292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42946Medicare UPIN