Provider Demographics
NPI:1386608628
Name:BUSTOS, JONAS GUINTO (MD)
Entity type:Individual
Prefix:
First Name:JONAS
Middle Name:GUINTO
Last Name:BUSTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 COLLEGE BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1606
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:913-297-1202
Practice Address - Street 1:1005 NORTH B ST
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449
Practice Address - Country:US
Practice Address - Phone:785-258-3705
Practice Address - Fax:785-258-3706
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416653208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100000370AMedicaid
828013454OtherMEDICARE TRAVELERS
001312OtherBCBS