Provider Demographics
NPI:1497703730
Name:BUZZINI, ROBERT JAMES (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:BUZZINI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-3330
Mailing Address - Fax:208-367-3331
Practice Address - Street 1:1075 N CURTIS ROAD
Practice Address - Street 2:STE 300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-367-3330
Practice Address - Fax:208-367-3331
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPA276363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP72391Medicare UPIN
ID805899000Medicaid