Individual
JORGE BUSTILLO
Active
Individual
JORGE BUSTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
D0078545
MD
207X00000X
Orthopaedic Surgery Physician
Primary
MD421803
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019586400010
—
PA
01
—
580344
MEDICARE
PA
05
—
745419800
—
MD
Enumeration date
04/17/2006
Last updated
04/02/2024
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