Provider Demographics
NPI:1225366727
Name:LUDIE HERNANDEZ-BUCK MDPA
Entity Type:Organization
Organization Name:LUDIE HERNANDEZ-BUCK MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-422-4792
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3167
Mailing Address - Country:US
Mailing Address - Phone:281-422-4792
Mailing Address - Fax:281-422-6099
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:SUITE 119
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-422-4792
Practice Address - Fax:281-422-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7780207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1239659-01Medicaid
TX00TG18Medicare PIN
TX1239659-01Medicaid