Provider Demographics
NPI:1811127624
Name:BUSSARD, MATTHEW (EMT-PARAMEDIC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BUSSARD
Suffix:
Gender:M
Credentials:EMT-PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-2032
Mailing Address - Country:US
Mailing Address - Phone:317-339-4505
Mailing Address - Fax:317-787-2802
Practice Address - Street 1:602 ASH ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-2032
Practice Address - Country:US
Practice Address - Phone:317-339-4505
Practice Address - Fax:317-787-2802
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN49-51970146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic