Individual
DR. RUDOLPH BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1856 E FLORENCE BLVD, CASA GRANDE, AZ 85122-5303
(520) 381-0380
(520) 836-1826
Mailing address
PO BOX 10097, CASA GRANDE, AZ 85130-0020
(520) 836-3446
(520) 836-8807
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
6500
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-1881
MEDICARE
—
01
—
03-31815
MEDICARE
—
05
—
510984
—
AZ
01
—
Z137312
MEDICARE
—
01
—
ZFQ31815
MEDICARE
—
Enumeration date
03/24/2006
Last updated
10/14/2011
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