Provider Demographics
NPI:1962494880
Name:BUSCH-DOBLE, ANGELA C (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:BUSCH-DOBLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:2310 VILLAGE SQUARE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6409
Practice Address - Country:US
Practice Address - Phone:904-264-6404
Practice Address - Fax:904-390-7455
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH07431Medicare UPIN
FL49561ZMedicare ID - Type Unspecified