Individual
SERGIO BUSTOS MUNOZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
368 NE FRANKLIN ST, LAKE CITY, FL 32055-3088
(386) 292-8000
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 778-8513
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
FTL# 43665
TX
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME128466
FL
2080P0203X
Pediatric Critical Care Medicine Physician
P2964
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200398620 A
—
OK
05
—
284782401
—
TX
05
—
284782402
—
TX
05
—
284782403
—
TX
05
—
284782404
—
TX
05
—
80287531
—
NM
Enumeration date
05/20/2010
Last updated
11/02/2016
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