Provider Demographics
NPI:1568458321
Name:BUENGER, KIMBERLY IERO (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:IERO
Last Name:BUENGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:3370 S TEXAS AVE
Practice Address - Street 2:#B
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3127
Practice Address - Country:US
Practice Address - Phone:979-595-1700
Practice Address - Fax:979-595-1740
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649265646OtherNPI CLINIC
TX187842301Medicaid
TX154467801Medicaid
TX741715140OtherTAX ID
TX1878423-01Medicaid
TX1275726853OtherNPI CSCHC CLINIC
TX1821185299OtherNPI AGENCY
TX1649265646OtherNPI CLINIC
TXH45744Medicare UPIN
TX671861Medicare Oscar/Certification