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General NPI Number Information
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NPI Number | 1548816721
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Entity Type | Organization
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Legal Business Name | BUFFALO FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 1686 W US HIGHWAY 79
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City | BUFFALO
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State | TX
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Zip | 75831-3490
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Country | US
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Telephone | 903-322-1290
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Fax | 903-322-1304
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Provider Business Mailing Address
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Address Line | PO BOX M
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City | BUFFALO
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State | TX
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Zip | 75831-0317
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Country | US
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Telephone | 903-322-1290
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Fax | 903-322-1304
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JULIE PICKENS
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Credential | APRN
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Telephone | 903-388-1058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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