Organization
BUDA FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY MOORE (DIRECTOR OF OPERATION)
(512) 342-0455
Entity
Organization
Contact information
Practice address
907 N LOOP 4, BUDA, TX 78610-5043
(512) 295-2121
(512) 295-2282
Mailing address
PO BOX 503968, SAINT LOUIS, MO 63150-0001
(512) 295-2121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G8683
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040JT
BCBS
—
01
—
3336011
AETNA GROUP
—
01
—
DC6156
RAILROAD MEDICARE GROUP
—
Enumeration date
07/12/2006
Last updated
08/22/2020
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