Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD001147 | GA |
N | 213ES0131X | Foot Surgery | 000834 | IA |
NPI | 1407189244 |
---|---|
Provider Name | Richard Phu Bui |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 16/12/2021 |