Healthcare Provider Details

I. General information

NPI: 1760585194
Provider Name (Legal Business Name): AARON KEITH BUZZARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10485 S FM 2038
BRYAN TX
77808
US

IV. Provider business mailing address

10485 S FM 2038
BRYAN TX
77808
US

V. Phone/Fax

Practice location:
  • Phone: 210-380-6017
  • Fax:
Mailing address:
  • Phone: 210-380-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101239139
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM9896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: