Organization
FORREST K BUSCH DO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE HORNER (OFF MGR)
(731) 286-4302
Entity
Organization
Contact information
Practice address
DYERSBURG SKIN CLINIC, 1950 COOK ST, DYERSBURG, TN 38024
(731) 286-4300
(731) 286-8008
Mailing address
PMB 363, 710 HWY 51 BYPASS, DYERSBURG, TN 38024
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
DO839
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4438037
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/07/2006
Last updated
08/22/2020
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