Individual
GORDON A BUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
C1-0000625
DE
207W00000X
Ophthalmology Physician
C10000625
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000055401
—
DE
01
—
180018339
MEDICARE RR
—
Enumeration date
05/17/2006
Last updated
04/19/2010
Update your record
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