Provider Demographics
NPI:1851514061
Name:JOSE D BUENO, M.D.,P.A.
Entity Type:Organization
Organization Name:JOSE D BUENO, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DOMIL
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-580-4170
Mailing Address - Street 1:808 TOWER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4239
Mailing Address - Country:US
Mailing Address - Phone:432-580-4180
Mailing Address - Fax:432-580-4091
Practice Address - Street 1:808 TOWER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4239
Practice Address - Country:US
Practice Address - Phone:432-580-4180
Practice Address - Fax:432-580-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9635208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110667603Medicaid
TX110667601Medicaid