Provider Demographics
NPI:1912402884
Name:BUSTAMANTE, CHRISTIAN EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:EDGAR
Last Name:BUSTAMANTE
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 1:2523 12TH SQ SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-5065
Mailing Address - Country:US
Mailing Address - Phone:772-559-2206
Mailing Address - Fax:
Practice Address - Street 1:NMRTC/NAVAL HOSPITAL YOKOSUKA JAPAN
Practice Address - Street 2:INAOKACHO, 82
Practice Address - City:YOKOSUKA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:238-0001
Practice Address - Country:JP
Practice Address - Phone:046-816-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6580207P00000X
FLME145628207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine