Individual
DR. NICOLAS VON DEM BUSSCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 HOAG DR, NEWPORT BEACH, CA 92663-4162
(949) 263-8620
(949) 263-1639
Mailing address
PO BOX 3095, NEWPORT BEACH, CA 92659-0659
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A79178
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A791780
BLUE SHIELD
CA
05
—
00A791780
—
CA
01
—
P00346064
RR MEDICARE
CA
Enumeration date
05/09/2006
Last updated
10/23/2007
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