Provider Demographics
NPI:1376856948
Name:BUITRAGO, WILLIAM FERNANDO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FERNANDO
Last Name:BUITRAGO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 GRAMERCY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1216
Mailing Address - Country:US
Mailing Address - Phone:713-459-6294
Mailing Address - Fax:
Practice Address - Street 1:810 WAUGH DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2000
Practice Address - Country:US
Practice Address - Phone:713-459-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9305208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery