Healthcare Provider Details

I. General information

NPI: 1487616785
Provider Name (Legal Business Name): BRUCE BAUKNIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6123 COUNTRY CLUB DR
VICTORIA TX
77904-1672
US

IV. Provider business mailing address

1908 N LAURENT ST STE 330
VICTORIA TX
77901-5467
US

V. Phone/Fax

Practice location:
  • Phone: 361-578-1430
  • Fax: 361-578-0876
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-371-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD4925
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberD4925
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD4925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: