Provider Demographics
NPI:1104801067
Name:BUSER, BOYD R (DO)
Entity type:Individual
Prefix:
First Name:BOYD
Middle Name:R
Last Name:BUSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HILLS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9526
Mailing Address - Country:US
Mailing Address - Phone:207-284-1417
Mailing Address - Fax:207-284-1560
Practice Address - Street 1:11 HILLS BEACH RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9526
Practice Address - Country:US
Practice Address - Phone:207-284-1417
Practice Address - Fax:207-284-1560
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1147204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0506Medicare ID - Type Unspecified
MEE11254Medicare UPIN