Healthcare Provider Details

I. General information

NPI: 1124047261
Provider Name (Legal Business Name): DMITRIY BUYANOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BABCOCK RD STE 108
SAN ANTONIO TX
78229-4899
US

IV. Provider business mailing address

2425 BABCOCK RD STE 108
SAN ANTONIO TX
78229-4899
US

V. Phone/Fax

Practice location:
  • Phone: 210-775-3455
  • Fax: 210-775-3455
Mailing address:
  • Phone: 210-775-3455
  • Fax: 210-775-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberL7996
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberL7996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: