Healthcare Provider Details

I. General information

NPI: 1811337504
Provider Name (Legal Business Name): PRINCE BUZOMBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SOUTH FWY
PEARLAND TX
77584-1895
US

IV. Provider business mailing address

PO BOX 58406
WEBSTER TX
77598-8406
US

V. Phone/Fax

Practice location:
  • Phone: 281-929-6184
  • Fax:
Mailing address:
  • Phone: 281-724-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ7660
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR74110
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberQ7660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: