Provider Demographics
NPI:1932505419
Name:GENERAL PHYSICIAN SUB III PLLC
Entity Type:Organization
Organization Name:GENERAL PHYSICIAN SUB III PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-692-2160
Mailing Address - Street 1:PO BOX 8000 DEPARTMENT 540
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:203-944-1940
Mailing Address - Fax:203-402-4192
Practice Address - Street 1:1430 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1440
Practice Address - Country:US
Practice Address - Phone:716-874-4060
Practice Address - Fax:716-874-0370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERAL PHYSICIAN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-12
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty