=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720337843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | W. COOPER BUSCHEMEYER III, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2012
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 LONGMIRE RD UNIT 102
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-646-3500
-----------------------------------------------------
Fax | 346-646-7799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 LONGMIRE RD UNIT 102
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-646-3500
-----------------------------------------------------
Fax | 346-646-7799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM COOPER BUSCHEMEYER III
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 346-646-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------