MEDICARE: MR. FERNANDO JOSE BUESO JR. MD.LSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	LSA-05-168	TX

General Provider Information

NPI Number	:	1154539146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FERNANDO JOSE BUESO JR. MD.LSA

Provider Business Mailing Address
First Line	:	PO BOX 111938
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77293-0938
Country	:	US
Telephone Number	:	713-882-9849
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 WILD INDIGO ST APT 274
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-7076
Country	:	US
Telephone Number	:	713-882-9849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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