Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 11631 | TX |
N | 1223P0106X | Oral and Maxillofacial Pathology | 1856 | NM |
NPI | 1245310416 |
---|---|
Provider Name | Dr. Robert Lanham Bucy |
First Address | El Paso, TX 79912-4245 |
Second Address | El Paso, TX 79936-5170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T-12447 | (02) | TX |