Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12711 | TX |
NPI | 1922122886 |
---|---|
Provider Name | Dr. William Aubrey Buche |
First Address | San Angelo, TX 76904-6975 |
Second Address | San Angelo, TX 76904-6975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D000421E2 | (05) | TX |
T12442 | (02) | TX |