Healthcare Provider Details

I. General information

NPI: 1114939253
Provider Name (Legal Business Name): RONALD VANBUSKIRK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIGHLAND AVE
SHERMAN TX
75092-7354
US

IV. Provider business mailing address

600 N HIGHLAND AVE 104
SHERMAN TX
75092-5601
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-4611
  • Fax:
Mailing address:
  • Phone: 903-870-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF6338
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: