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General NPI Number Information
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NPI Number | 1235327065
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Entity Type | Organization
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Legal Business Name | BUDA MEDICAL AND SURGICAL CLINIC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1305 WONDER WORLD DR STE 206
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City | SAN MARCOS
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State | TX
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Zip | 78666-7546
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Country | US
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Telephone | 512-396-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CIMARRON PARK LOOP
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City | BUDA
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State | TX
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Zip | 78610-2849
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Country | US
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Telephone | 512-295-6333
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LARRY DALO
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Credential |
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Telephone | 512-396-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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