Healthcare Provider Details

I. General information

NPI: 1275025850
Provider Name (Legal Business Name): ANGELA BUIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 12/21/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N SAM HOUSTON PKWY E
HOUSTON TX
77060-4018
US

IV. Provider business mailing address

505 N SAM HOUSTON PKWY E STE 690
HOUSTON TX
77060-4094
US

V. Phone/Fax

Practice location:
  • Phone: 281-410-1186
  • Fax:
Mailing address:
  • Phone: 979-997-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number080295Y98
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: