Provider Demographics
NPI:1962448811
Name:BUCZEK, RONALD ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALAN
Last Name:BUCZEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 FOREST XING
Mailing Address - Street 2:SUITE E
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1155
Mailing Address - Country:US
Mailing Address - Phone:281-363-2829
Mailing Address - Fax:281-292-1201
Practice Address - Street 1:9006 FOREST XING
Practice Address - Street 2:SUITE E
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1185
Practice Address - Country:US
Practice Address - Phone:281-363-2829
Practice Address - Fax:281-292-1201
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9742208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158920201Medicaid
TXH58080Medicare UPIN
TX8A9855Medicare ID - Type UnspecifiedMEDDICARE PROVIDER NUMBER