Provider Demographics
NPI:1619733631
Name:BUATTI, JACOB (MSC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BUATTI
Suffix:
Gender:M
Credentials:MSC
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Mailing Address - Street 1:8415 FREDERICKSBURG RD APT 707
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3351
Mailing Address - Country:US
Mailing Address - Phone:319-471-0519
Mailing Address - Fax:
Practice Address - Street 1:2280 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7321
Practice Address - Country:US
Practice Address - Phone:214-645-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX7802552085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics