Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | K7677 | TX |
NPI | 1003920760 |
---|---|
Provider Name | Michael E. Buxbaum |
First Address | Bellaire, TX 77402-0873 |
Second Address | Houston, TX 77081-5339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043941601 | (05) | TX |
108343 | AMERIGROUP (01) | TX |
H00609 | (02) | TX |