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NPI Code Detail

MEDICARE: MARYLOU BUYSE MD

MEDICARE: MARYLOU BUYSE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist38004MA
2208000000XPediatrics PhysicianN8620TX
3207SG0201XClinical Genetics (M.D.) PhysicianN8620TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386625135
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYLOU BUYSE MD
Provider Business Mailing Address
First Line : PO BOX 847408
Second Line :
City : DALLAS
State : TX
Zip : 75284-7408
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7700 FISH POND RD
Second Line :
City : WACO
State : TX
Zip : 76710-1031
Country : US
Telephone Number : 254-724-2111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 12/05/2011

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