Provider Demographics
NPI:1366550808
Name:BUSTER, EDWIN R III (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:R
Last Name:BUSTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:D-4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-454-9627
Mailing Address - Fax:512-454-6310
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:D-4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-454-9627
Practice Address - Fax:512-454-6310
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD0073207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128062004Medicaid
D0073OtherTX LICENSE
D0073OtherTX LICENSE
TXOOGT80Medicare ID - Type Unspecified
TXAB2948391OtherDEA