Provider Demographics
NPI:1235327065
Name:BUDA MEDICAL AND SURGICAL CLINIC
Entity Type:Organization
Organization Name:BUDA MEDICAL AND SURGICAL CLINIC
Other - Org Name:DONNA DOLAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-396-1525
Mailing Address - Street 1:112 CIMARRON PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2849
Mailing Address - Country:US
Mailing Address - Phone:512-295-6333
Mailing Address - Fax:
Practice Address - Street 1:1305 WONDER WORLD DR
Practice Address - Street 2:STE 206
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7546
Practice Address - Country:US
Practice Address - Phone:512-396-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9771OtherBCBS