Provider Demographics
NPI:1952577546
Name:BUXIE, CARALEIGH NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:CARALEIGH
Middle Name:NICOLE
Last Name:BUXIE
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 1:4450 TUBBS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6308
Mailing Address - Country:US
Mailing Address - Phone:972-722-3290
Mailing Address - Fax:972-722-3815
Practice Address - Street 1:4450 TUBBS RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6308
Practice Address - Country:US
Practice Address - Phone:972-722-3290
Practice Address - Fax:972-722-3815
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6593174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320241YN0QOtherMCPTAN
TX330275401Medicaid
TXP6593OtherTX ST LICENSE
TXP01274849OtherRR MC
TXP6593OtherTX ST LICENSE