Provider Demographics
NPI:1851569891
Name:BUOT, VANESSA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:GAIL
Last Name:BUOT
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 1:1105 CENTRAL EXPY N STE 235
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6135
Mailing Address - Country:US
Mailing Address - Phone:972-747-6042
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N STE 235
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6135
Practice Address - Country:US
Practice Address - Phone:972-747-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20531207RG0300X
TXT7176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine