Healthcare Provider Details

I. General information

NPI: 1801056122
Provider Name (Legal Business Name): BRUCE M BAUKNIGHT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
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: 361-703-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE M BAUKNIGHT
Title or Position: OWNER
Credential: MD
Phone: 361-578-1430