Individual
MR. JACQUES EMILE BUSSIERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
2453 KENBROOK CT, WALDORF, MD 20603-3227
(301) 257-6191
Mailing address
PO BOX 221135, CHANTILLY, VA 20153-1135
(703) 349-1379
(703) 591-0005
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4887
NSAA
DC
Enumeration date
10/12/2018
Last updated
05/15/2026
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