Provider Demographics
NPI:1215907902
Name:BUSTEED, TIMOTHY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:BUSTEED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-6218
Mailing Address - Country:US
Mailing Address - Phone:252-727-5200
Mailing Address - Fax:252-727-5205
Practice Address - Street 1:4725 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-6218
Practice Address - Country:US
Practice Address - Phone:252-727-5200
Practice Address - Fax:252-727-5205
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00007282OtherPALMETTO RAILROADMEDICARE
360659700OtherUS DEPT OF LABOR
12005OtherBLUE CROSS BLUE SHIELD
NC8912005Medicaid
A7584OtherMEDCOST
7817530001OtherCIGNA
2002110Medicare PIN
G64929Medicare UPIN