Provider Demographics
NPI:1821079930
Name:BUCAY, VIVIAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:W
Last Name:BUCAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 W CRAIG PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3307
Mailing Address - Country:US
Mailing Address - Phone:210-692-3000
Mailing Address - Fax:210-692-3056
Practice Address - Street 1:326 W CRAIG PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3307
Practice Address - Country:US
Practice Address - Phone:210-692-3000
Practice Address - Fax:210-692-3056
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH06420Medicare UPIN
TX8F20650Medicare PIN