Basic Information
| Provider Information | |||||||||
| NPI: | 1184745010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSBY | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BUSBY | ||||||||
| OtherFirstName: | JOSEPH | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | JR. | ||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2106 LOOP RD STE B | ||||||||
| Address2: | PO BOX 1575 | ||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712953343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184353771 | ||||||||
| FaxNumber: | 3184357233 | ||||||||
| Practice Location | |||||||||
| Address1: | 2106 LOOP RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712953342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184353771 | ||||||||
| FaxNumber: | 3184357233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | LA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.