Healthcare Provider Details

I. General information

NPI: 1023129525
Provider Name (Legal Business Name): MR. ALBERT BUISSERETH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 FM 2920 RD STE 204
SPRING TX
77379-3401
US

IV. Provider business mailing address

14414 228TH ST
LAURELTON NY
11413-3655
US

V. Phone/Fax

Practice location:
  • Phone: 281-378-4707
  • Fax: 281-378-4709
Mailing address:
  • Phone: 956-292-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number64607
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: