Healthcare Provider Details

I. General information

NPI: 1104104553
Provider Name (Legal Business Name): PETER BUHAY CNIM, R. EEG T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIGHLAND PARK VLG STE 100-225
DALLAS TX
75205-2789
US

IV. Provider business mailing address

25 HIGHLAND PARK VLG STE 100-225
DALLAS TX
75205-2789
US

V. Phone/Fax

Practice location:
  • Phone: 214-536-1647
  • Fax: 214-580-7600
Mailing address:
  • Phone: 214-536-1647
  • Fax: 214-580-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number4316
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: